REPUBLIC OF SLOVENIA
MINISTRY OF HEALTH
Štefanova 5, 1000 Ljubljana, Slovenia
Tel: 01-478 60 01
Fax: 01-478 60 58
National Health Enhancing Physical
Activity Programme
2007-2012
Ljubljana 2007
CONTENT
1
INTRODUCTION ....................................................................................................................................... 4
1.1
Definition of Terms and a List of Abbreviations and Foreign Words.................................................. 4
1.1.1
List of Abbreviations and Foreign Words .................................................................................. 4
2
1.2
Importance of Regular Physical Activity for Health ............................................................................ 4
1.3
International Political Background ...................................................................................................... 7
1.4
International Legislation and Documentation (of the European Community and other organisations
and alliances) in the Health Enhancing Physical Activity Area ........................................................... 8
1.5
The Mission, Basic Aims and Goals of the Health Enhancing Physical Activity Strategies of the
Republic of Slovenia ............................................................................................................................ 9
1.6
Actions Plans (2007-2012) of the National Health Enhancing Physical Activity Programme ............ 9
1.7
Principles in the Strategy of the National Healthy Lifestyle and Health Enhancing Physical Activity
Programme ......................................................................................................................................... 10
1.8
The Role of Intersectoral Cooperation for the Strategies of the National Health Enhancing Physical
Activity Programme ........................................................................................................................... 10
1.9
The Role of Local Communities in the Promotion of a Healthy Lifestyle and Health Enhancing
Physical Activity ................................................................................................................................ 12
1.10
The Role of Cooperation with Nongovernmental Organisations regarding Health Enhancing Physical
Activity .............................................................................................................................................. 12
PILLARS OF HEALTH ENHANCING PHYSICAL ACTIVITIES .................................................... 13
2.1
2.1.1
2.1.2
2.1.3
2.1.4
2.2
3
Professional Definitions, Guidelines and Recommendations on Health Enhancing Physical Activities
........................................................................................................................................................... 14
Definition ................................................................................................................................. 14
Guidelines and Recommendations ........................................................................................... 14
Summary of Recommendations concerning Physical Activity for Adult Population ............... 15
Guidelines on Healthy Dietary Habits Based on a Dietary Model - Food Based Dietary
Guidelines (FBDG): ................................................................................................................. 16
Goals of the Strategy in the National Health Enhancing Physical Activity Programme (2007-2012)17
DISEASES ASSOCIATED WITH INSUFFICIENT PHYSICAL ACTIVITY ................................... 18
3.1
Life expectancy and premature mortality........................................................................................... 18
3.2
Geographic distribution of age-standardized mortality rates ............................................................. 19
3.3
Prematurely lost years of potential life .............................................................................................. 20
3.4
Chronic non-communicable diseases ................................................................................................. 21
3.4.1
Cardiovascular disease ............................................................................................................. 21
3.4.2
Cancer....................................................................................................................................... 23
3.4.3
Obesity ..................................................................................................................................... 24
3.4.4
Diabetes .................................................................................................................................... 24
3.4.5
Osteoporosis ............................................................................................................................. 25
3.5
Common risk factors for the occurrence of CND .............................................................................. 26
Low level of physical activity – an important risk factor associated with unhealthy lifestyle in the
Slovenian population.......................................................................................................................... 27
3.6.1
Low level of health enhancing physical activity ...................................................................... 27
3.6.1.1
Children and adolescents ..................................................................................................... 27
3.6.1.2
Adult population .................................................................................................................. 30
3.6.1.3
Persons aged 65 years and above ......................................................................................... 33
3.6
2
3.6.1.4
Pregnant women .................................................................................................................. 34
3.7
Characteristics of the most threatened population groups due to unhealthy lifestyle ........................ 34
3.8
Summary of key problems in the field of health enhancing physical activity in Slovenia ................. 35
3.9
The Promotion of Health Enhancing Physical Activity Field ............................................................ 36
3.9.1
Strategic Aims of the Field ....................................................................................................... 36
3.9.2
Strategies for establishing and upgrading a healthy lifestyle with an emphasis on health
enhancing physical activities of individual target groups ......................................................... 37
3.9.2.1
Children and adolescents ..................................................................................................... 37
3.9.2.2
Adults .................................................................................................................................. 38
3.9.2.3
Population aged 65 years and above .................................................................................... 39
3.9.2.4
Pregnant Women ................................................................................................................. 40
3.9.2.5
Families ............................................................................................................................... 40
3.9.2.6
Persons with Special Needs ................................................................................................. 41
3.9.2.7
Promotion of education and training of professional personnel from the tourist sector in
healthy lifestyles and health enhancing physical activity in tourist environments .............. 42
3.9.2.8
Introduction of a licensing system for advisors and providers of health enhancing physical
activities ............................................................................................................................... 42
3.9.3
Strategy for increased accessibility and quality of health enhancing physical activities .......... 43
3.9.3.1
Improved offer of quality programmes in health enhancing physical activities .................. 43
3.10
Physical Activity in the Work Environment ...................................................................................... 44
3.10.1
Strategic goals of the field ........................................................................................................ 44
3.10.1.1
Establish the culture of health enhancing physical activities during work and expand
their programmes into work environments ..................................................................... 44
3.10.2
Health enhancing physical activity strategies in the working environment .............................. 45
3.10.2.1
Promotion, development and implementation of health and physical activity promotion
programmes for workers ................................................................................................. 45
3.11
The Field of Transport-Related Health Enhancing Physical Activity ................................................ 46
3.11.1
Strategic goals of the field ........................................................................................................ 46
3.11.1.1
Establish the culture of health enhancing physical activity related to transportation in all
population groups and provide conditions for safe walking and cycling ........................ 46
3.11.2
Strategies for increasing active transportation modes to enhance health .................................. 47
3.11.2.1
Promotion of transportation modes involving health enhancing physical activity and
improvement of traffic infrastructure for pedestrians and cyclists .................................. 47
4
PROGRAMME EVALUATION AND HEALTH INDICATORS ........................................................ 48
3
National Health Enhancing Physical Activity Programme
2007-2012(draft)
1
1.1
INTRODUCTION
Definition of Terms and a List of Abbreviations and Foreign Words
1.1.1 List of Abbreviations and Foreign Words
CND
chronic noncommunicable diseases
CVD
cardiovascular diseases
EU
European Union
CINDI
Countrywide Integrated Noncommunicable Diseases Intervention
Programme - Countrywide Integrated Noncommunicable Diseases
Intervention Programme Diseases
TRP
targeted research projects
DG SANCO Directorate General for Health and Consumers Affairs;
EFSA
European Food Safety Authority
WHO - SZO World Health Organisation
HBSC
Health Behaviour in School-aged children;
IOTF
International Obesity Task Force;
BMI
body mass index;
IVZ RS
Institute of Public Health of the Republic of Slovenia;
NGO
Non-governmental organizations;
MET
measurement unit for expressing the intensity of physical activity,
expressed in the amount of kJ used per unit of time. Quantity-wise this
means 1 MET 3.5 ml of oxygen per minute per kilogram of body weight
FBDG
Food Based Dietary Guidelines (guidelines on healthy nutrition based
on dietary habits)
1.2
Importance of Regular Physical Activity for Health
Health plays an important role in ensuring a high quality of life and is one of the basic
conditions for the development of any society. There is no area of social life that is not
influenced by health. Health is primarily every individual’s own responsibility while the state,
in cooperation with various professional organisations and sciences, has the power and
responsibility to create the conditions that allow people to maintain a healthy lifestyle. Apart
from ensuring health care, the state looks after health by developing, adopting and
implementing health promotion policies, strategies and programmes. The strategy of
protection and promotion of health by physical activity, sport and recreation falls within these
responsibilities as well.
Insufficient physical activity is one of the most important factors of unhealthy lifestyle, in
addition to unhealthy diets, smoking, illicit drugs, stress, and alcohol consumption. It has been
proven scientifically that the above stated factors of unhealthy lifestyle are the leading causes
in the processes of development, progression, and complications related to major chronic noncommunicable diseases (CND): cardiovascular and diabetic diseases, some types of cancer,
some chronic lung diseases, obesity, osteoporosis, and other types of musculoskeletal
diseases. Insufficient physical activity and unhealthy dietary habits are closely related to the
development and persistence of known physiological risk factors in relation to CNDs such as
4
high blood pressure and pathologically changed levels of blood fats (especially higher
cholesterol and blood sugar levels). At least five of the seven major risk factors for CND
(high blood pressure, a high level of blood cholesterol and body mass index, insufficient
intake of vegetables and fruit, excessive consumption of alcohol, smoking) are closely linked
to the lack of physical activity and unhealthy nutrition.
In 2002 it was estimated that CNDs were the cause of death in 86 % of all cases in Europe
and of morbidity in 77 % of all cases. Next in line among the most common causes of death
are cardiovascular diseases (CVD), cancer, respiratory diseases, digestive tract and
neuropsychiatric diseases. CVDs caused almost half of all deaths, while it is worth
mentioning that in some new EU Member States they are a three-times more common cause
of death when compared to the situation in the western EU Member States. In the EU, CVD is
the prevailing disease (23 %), followed by neuropsychiatric diseases (20 %) and cancer (11
%).
In Slovenia, too, 70 % of all deaths result from the most common forms of chronic noncommunicable diseases (CND). The leading cause is CVD, which continues to appear in 40 %
of total deaths in the Slovene population in spite of the fact that from 1990 till 2002 the
mortality rate related to cardio-vascular diseases dropped by 34 %. In comparison with
countries in transition, the total mortality rate in Slovenia is lower; however, it is still greater
than the rate in the majority of West European countries. Namely, we are on average two
years behind it, and the same is true for life-expectancy at birth which is currently 72 years for
men and 79 years for women. In 2002, the percentage of premature deaths, i.e. before the age
of 65 and preventable, amounted to 26 % in Slovenia; 32.7 % of these were caused by various
types of cancer and 19.9 % by the diseases of the circulatory system. It is important to
mention that both morbidity and mortality caused by cancer are increasing. In the period from
1980 until 1999, the morbidity rate increased by 64 % among men and 51 % among women,
while the mortality rate by 33 % among men and 29 % among women. Cancer morbidity is
rising due to the ageing of the population. In Slovenia, over-nutrition and obesity, otherwise a
common characteristic of the developed world, are also showing an upward trend. National
research carried out during recent years shows that in total 58.2 % of Slovenes are overfed
and that as much as 18.8 % of persons can be categorised as obese. Morbidity from diabetes
has been estimated at approximately 5% to 6 % of the entire population.
A very important health maintaining and enhancing determinant is the ratio between energy
intake and energy output, or in short, between food consumption and physical activity. A
healthy diet and regular physical activity have an impact on health both individually and
synergistically. Regardless of the fact that the two produce an aggregate effect – something
that becomes very obvious when reducing overweight and obesity problems –, physical
activity can have positive effects on health independently of dietary habits. It is well known
that intense exercise is not required in order to maintain health; contemporary scientific
findings demonstrate that the risk of the development and progress of cardiovascular diseases
and the related physiological risk factors can be significantly reduced by half an hour of
moderate physical activity during the majority of weekdays. In this regard, it is essential that
physical activity is present throughout a lifetime in order to keep physical, mental and social
wellbeing from childhood until old age. By preserving muscular strength, mobility and
balance in older population, functional abilities are maintained, injuries prevented, and
possibilities of active ageing significantly increased, while the economic burden of illness for
the state is considerably decreased.
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Data on physical activity of the adult Slovene population, obtained on the basis of different
observation points, are quite varied. The research study „Z zdravjem povezan življenjski slog“
(2001)(Health-related Lifestyle), which studied all physical activity, i.e. in free time, in the
household and at work, reveals that at least 20 % of the adult Slovene population in the age
bracket of 25-64 years, are not active enough to ensure the basic protection of health.
Crosscut studies, carried out in Ljubljana within the WHO CINDI programme during
1990/91, 1996/97 and 2002/03, with the latter two carried out also in two other demonstration
regions of Slovenia (Pomurje, Severna Primorska), revealed that in terms of free-time activity
only about one third of adults are physically active enough to protect their health. In the
period 1990-1997, the proportion of persons who can be considered marginally physically
active fell to 40%, primarily as a result of an increase in the proportion of those who are
physically completely inactive which increased from 15% to 25 %. The most recent CINDI
Slovenia research study (2002/03), focusing on adults (in the age group 25-65), was also a
part of a wider national Targeted Research Project (TRP) "Physical exercise/sport activity for
health” and was supported by the ministry responsible for health and the ministry responsible
for science. The TRP study defined the categories in terms of the regularity and frequency of
physical activity in a slightly different manner than previous research studies due to the fact
that it took into consideration some current findings on the role and importance of moderate,
although regular, free-time physical activity (e.g. fast walking). It was discovered that among
adult Slovene population, 32.4% of those in the age group 25-64 years are sufficiently
physically active to protect their health (5 and several times a week at least 30 minutes of
walking or moderate to intense physical activity). On the other side of the spectrum, 16.8 %
of adult Slovenes are not physically active at all. Minimally physically active are 35.5 % of
them; marginally active, from the health protection point of view, are 15.3 % of adults. When
comparing the results by the studied categories of physical activity in the region of Ljubljana
(its population was involved in the CINDI Ljubljana research in 1990/91 and 1996/97), it
becomes evident that the circumstances in the area of adult physical activities have changed
for the better during the last six years.
A slightly worse picture was obtained on the basis of a study on sport and recreation activities
(2000) which demonstrated that in our country almost 60 % of adult population are sport- and
recreation-wise inactive, slightly less than a quarter are occasionally active, and considerably
more than a fifth are regularly, at least twice weekly, active. A longitudinal analysis of
physical activity of the adult population of Slovenia until 2000 showed a gradual decrease in
sport and recreation activities proportionally to an increase in age, and furthermore, it
revealed that more women than men are inactive in the population (i.e. 63.2 % and 44.1 %).
In this respect the results, obtained by the above stated TRP (2002/2003), are more
encouraging from the point of view of public health in Slovenia. They show that actually as
much as 47.3 %, and occasionally additional 42.3 %, of the Slovene adult population
participate in at least one type of physical activity. Furthermore, it became evident that an
important improvement with regards to the annulment of gender differences has also
occurred. It must be emphasised that the greatest number of regularly as well as occasionally
active persons are found in the category of non-organised activities meaning that they make
arrangements for their physical activity on their own. The proportion of the population
participating in various forms of organised physical activities (in sport clubs, societies, either
under private ownership or within a work organisation) is relatively small.
In the developed world, the greatest part of available resources is used for the treatment of
CNDs and their resulting complications. In the majority of such cases, the economic burden
exceeds the available health insurance coverage so that, today already, a relatively significant
6
proportion of the total cost of treatment must be covered by patients and/or their families.
Indirect morbidity costs, in the sense of lost workdays or lessened productivity, are equal or
even exceed direct treatment costs or mortality costs, the latter held particularly true for the
diseases of the circulatory system and for diabetes. Using the method of calculation of human
capital costs in 2002, the resulting figure amounted to as much as SIT 114.6 billion in
economic losses. It is therefore rather urgent to undertake various measures for restraining or
reducing the total cost of health services and the demand for them, and in this regard, the
importance of maintaining and improving health and functional abilities of the ageing
population is growing, at least in the developed world.
A healthy lifestyle allows just that, it preserves and enhances health and the quality of life of
each individual, in addition to reducing the costs of prevention and treatment of chronic noncommunicable diseases, of disability, and of precipitated mortality. The negative effects of
individual elements of unhealthy lifestyle complement each other so that several risk factors
often concur with the same individual. It is therefore sensible and necessary that policies are
developed and effective strategies for the reduction of major risk factors are implemented in
parallel - along with the endeavours to reduce the use of alcohol and tobacco in addition to the
promotion and provision of healthy diets and regular, moderate health enhancing physical
activity, all of which are contained in this document.
1.3
International Political Background
The member states of the Amsterdam Treaty of the European Community are bound by the
Treaty’s Article 152 to establish and implement in all their policies and activities a high level
of health protection for the population.
The European member states of the World Health organisation (WHO) are the signatories of
the umbrella health programme - the “Health Agenda for the 21st century". The main goal of
the document is to achieve the highest possible level of health of each individual and to
enhance as well as protect the health of the entire population. “The Health Agenda for the 21st
Century” has 21 goals which cover, in addition to the healthy environment, the area of safe
food and healthy nutrition as well. In this document, the member states strive for a healthy
start of life, healthy young people and healthy ageing, reduced incidence of acute
communicable diseases and chronic noncommunicable diseases, a healthy and safe physical
environment, a healthy lifestyle, the reduction of harm due to alcohol abuse, and a healthy
residential environment. The document acknowledges the importance of multisector
responsibility for health. The World Health Organisation, responsible for the management of
tasks in Chapter 6 of the document, plays an important role in the implementation of health
goals in the Agenda.
The Council Conclusions on Healthy Lifestyle: education, information, communication (OJ
EU, 2004/C 22/01) stipulate that a significant part of the social activities programme in the
public health area (2003-2008) is Activities should be implemented by preparing and
implementing the strategies regarding the entire lifestyle (alcohol, tobacco, diet, physical
activity). During the preparation of strategies in various areas of healthy lifestyle, a range of
partners in the fields of social affairs, the environment, agriculture and transport are involved.
The Council of Europe Conclusions in the field of heart health promotion (9627/04) contain a
report that the citizens of the EU ascribe great and priority importance to the quality of life,
7
which depends much on the state in the domain of cardiovascular diseases. As a matter of
fact, cardiovascular diseases are the most common cause of morbidity, mortality, premature
death, and of the poorer quality of life among EU citizens. Cardiovascular diseases can be
reduced by applying two appropriate methods, namely, the promotion of health and disease
prevention, which should both be implemented within the scope of national public health
policies.
In spring of 2003, a meeting of food representatives from the World Health Organisation was
held in Athens, in conjunction with the Greek initiative in the European Union, during which
the importance of harmonised healthy nutrition and regular physical activity policies for the
health of population was emphasised at the highest professional level. The meeting made it
possible to assess the situation regarding nutrition policy preparation. It also provided an
opportunity for an exchange of experience of various European countries in their preparation
of nutrition policy action plans as well as allowed a review of possibilities for a successful
enactment and implementation of the nutrition policy and for the promotion of health
enhancing physical activity, especially through intersectorial cooperation.
In May 2004, the World Health Organisation adopted the Resolution on a Global Strategy on
Diet, Physical Activity, and Health. The Strategy links nutrition and physical activity within a
common effort to reduce the burden of CNDs. Some countries have already followed the
orientation of the Global Strategy of the World Health Organisation by producing similar and
integral documents on diet and physical activity. Spain produced a strategy on a healthy diet,
physical activity and the prevention of obesity, Sweden issued a governmental regulation on
healthy diet and the promotion of physical activity, Northern Ireland a strategy and an action
plan entitled “Be active – Be healthy”, and a document of the Dutch Ministry of Health,
Welfare and Sport has a similar content. Similar adopted governmental documents exists
outside the EU as well, namely, in the USA, Canada and Australia, such as the Australian one
entitled “Active Australia: simply active every day - a plan to promote physical activity«.
In the domain of public health, the European Commission established in 2003 the European
Network on Nutrition and Physical Activity which has a mandate for the period 2003-2008.
The network will become a forum for the discussion and exchange of information and for the
presentation of proposals for strategies, action programmes, pieces of legislation and
recommendations based on a consensus of participating Member States. The main activity
areas are: support to national programmes for healthy nutrition and physical activity;
identification of programmes that have proven successful in individual member states;
research on lifestyles or health determinants and the establishment of a joint European
information system. Through the network, the Directorate General of Health and Consumer
Protection (DG SANCO) will liaise with directorates of public health, sport, research,
agriculture and education, and EFSA (the European Food Safety Agency).
1.4
International Legislation and Documentation (of the European Community and
other organisations and alliances) in the Health Enhancing Physical Activity Area
The European Community legislation (in a wider context) touches upon public health and
physical activity and sport in the following places:
 in Article 3 of the Treaty, on removing the obstacles to the free movement of goods,
persons, services and capital;
 in Article 43 – freedom of establishment;
8
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in Article 49 – on the implementation of services;
in Article 82 – on the abuse of a dominant position;
in Article 87 – on discrimination linked to nationality and citizenship, and especially
in article 87 – on state aid;
152. in Article 152 - on public health;
in Decision No. 1786/2002/EC of the European Parliament and of the Council
(23.9.2002) on the adoption of the document: “Action Programme 2003-2008 on
health protection, abuse of certain substances (alcohol, tobacco...) and physical
activity and healthy diet";
in Annex to the Amsterdam Treaty (2 October 1997) – “Declaration on Sport” which
emphasises social significance and meaning of amateur sport;
in some conventions of the Council of Europe on spectator violence and misbehaviour
(1987), on the fight against doping (1989), and the recognition of the legal to
international non-governmental organisations (1986).
In World Health Organisation Documents:
 WHO (WHA55/23) Assembly – May 2002: the adopted resolution on physical
activity for health “Move for Health, Active Youth, Move your Body, Strech your
Mind«;
 WHO (WHA57/17) Assembly – 2004: the adopted strategy »Global Strategy on Diet,
Physical Activity and Health«.
1.5
The Mission, Basic Aims and Goals of the Health Enhancing Physical Activity
Strategies of the Republic of Slovenia
The strategies of the national programme on the promotion of health enhancing physical
activity are exercised through the planning and implementation of national measures and
activities in cooperation with various publics and organisations of the civil society. All of
them enhance and improve the quality and healthy nutrition and regular physical activity of
the citizens of the Republic of Slovenia, and consequently, protect and strengthen their health
and quality of life.
The basic goal of the national programme for the promotion of health enhancing physical
activity is to encourage all forms of regular physical activity and exercise aiming to enhance
health and to be maintained throughout the entire lifetime.
A healthy diet and recommended forms and scope of physical activity produce a synergic
health effects and greatly contribute to the prevention of disease, early mortality and
disability, and to a greater quality of life of the Slovene population.
1.6
Actions Plans (2007-2012) of the National Health Enhancing Physical Activity
Programme
The ministry responsible for health is the coordinating body in the implementation of the
national programme and is responsible for preparing proposals for action plans, their
coordination with the line ministries, and finally, for ensuring coordinated implementation of
measures, tasks and activities.
9
Following consultations with the line ministries, the Ministry of Health annually prepares a
proposal for measures, tasks and activities to be implemented in the current fiscal year.
Specific goals of individual measures, tasks and activities, including project operators,
methods and amounts of project financing and implementation deadlines, will be defined in
more detail in annual action plans.
Action plans for the implementation of the national health enhancing physical activity
programme in individual fiscal periods are approved by the Government of the Republic of
Slovenia (hereinafter: the Government).
1.7
Principles in the Strategy of the National Healthy Lifestyle and Health Enhancing
Physical Activity Programme
In planning and implementing the strategies of the National Health Enhancing Physical
Activity Programme, the following principles should be taken into consideration:
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1.8
honouring the right to a healthy lifestyle and health enhancing physical activity;
respecting ethical principles – shared social, moral and environmental responsibility of
all tenderers, providers and users of organised and unorganised health enhancing
physical activity;
sharing responsibility and representing proportionally all policies of the line ministries
in the implementation of a healthy lifestyle and health enhancing physical activity
strategies, and adhering to the establishment and implementation of health enhancing
measures within the framework of health preserving and enhancing policies;
taking into consideration the achievements of science and the developments of various
professions;
supporting clinical and epidemiological research in the areas of healthy lifestyle and
health enhancing physical activity;
asserting a special concern of the society for a healthy lifestyle and regular physical
activity of the groups of population whose health is at risk;
exercising the rights of consumers and their protection;
involving in a proactive manner the interested professional and lay publics and NGOs;
taking into account the financial capabilities of the state.
The Role of Intersectoral Cooperation for the Strategies of the National Health
Enhancing Physical Activity Programme
In order to develop effective strategies for the promotion and enhancement of a healthy
lifestyle and physical activity, it is necessary to establish coordinated operation of various
government ministries.
The planning and implementation of the strategies for health enhancing physical activities is
implemented with regards to various policies, such as:
 health policy,
 transport policy,
 economic policy,
10
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social,
regional and cohesion policy,
educational policy,
research policy,
environmental protection and other policies.
In Slovenia, a major role in the development and implementation of strategies for health
enhancing physical activities is assumed by the ministry responsible for health, the ministry
responsible for education and sport, the ministry responsible for transport, the ministry
responsible for the environment and spatial planning, and the ministry responsible for labour,
family and social affairs.
The ministry responsible for health has a key role in health education and awareness building,
in the preparation of recommendations for a healthy lifestyle and health enhancing physical
activity of various population groups in different environments; it is also responsible for the
development of programmes and adequate implementation of health services with an
organised approach to the prevention of diseases, screening, and appropriate prevention as
well as health treatment and education of individuals and groups at risk of CNDs. It is
especially important that the primary health sector implements the necessary preventive
programmes and ensures their coordinated interfacing with the programmes developed and
implemented by the secondary and tertiary health service sectors. A general promotion of
health enhancing physical activity is a joint task of all responsible ministries.
The ministry responsible for education and sport provides the relevant educational and
training process on the topic of healthy lifestyles and health enhancing physical activities
including the necessary conditions to ensure the above in kindergartens, elementary, technical
and secondary schools.
The ministry responsible for transport plays an important role in promoting a healthy lifestyle
and health enhancing physical activities through its planning and implementation of a healthfriendly traffic policy together with the planning and construction of an adequate number of
safe cycle paths and footpaths allowing safe cycling and walking.
The ministries responsible for labour and health both play an important role, together with the
representatives of employers, employees, trade unions and other interest groupings, in
providing relevant legislation and programmes for a safe and healthy work environment and
for promoting a healthy lifestyle and health enhancing activity both at work and in the wider
living environment.
The ministry responsible for the environment and spatial planning has an important role in
facilitating a healthy lifestyle and health enhancing physical activity through adequate
planning of physical space. Physical planning with a focus on adequate playground areas,
parks, areas intended for sport and recreational activities, cycling and walking, makes it
possible for an aware and well informed individual and groups of population to decide easily
(as part of the daily routine) for health enhancing physical activities and an active lifestyle in
their narrow and wider living environment.
The ministry responsible for higher education and science influences a healthy lifestyle and
health enhancing physical activity through the approval of appropriate educational
11
programmes for undergraduate and graduate studies in specific professions and through the
promotion and financing of research in this area.
1.9
The Role of Local Communities in the Promotion of a Healthy Lifestyle and
Health Enhancing Physical Activity
Local communities have a key role in facilitating and promoting a healthy lifestyle and health
enhancing physical activity through the specific planning and construction of infrastructure –
playgrounds, parks, cycle and foot paths, gymnastic and training areas, as well as through the
encouragement of financing and co-financing of programmes promoting a healthy lifestyle,
health enhancing physical activities, training programmes, and sport and recreation
programmes.
1.10 The Role of Cooperation with Nongovernmental Organisations regarding Health
Enhancing Physical Activity
Aiming to achieve a more efficient involvement of NGOs in political dialogue, the
Government of the Republic of Slovenia adopted in October 2003 the Strategy for a Systemic
Development of NGOs in Slovenia during the period 2003-2008. This document defines the
significance of cooperation of NGOs in achieving a comprehensive and sustainable social
development, in addition to improving the well-being of the society, its quality of life and
social security.
Several NGOs in Slovenia have the characteristics which make them capable of considerably
contributing to the achievement of goals set by the healthy lifestyle policy. NGOs are
organised and operate in various ways (as societies/clubs or associations, private institutes
and foundations), and all of them can contribute to the enactment of policies and achievement
of goals in action plans in their own specific way: by involvement of their members (e.g.
societies or associations) or by professional, developmental and research work (private
institutes, foundations).
NGOs are active and possess specialised knowledge or experts in the areas that are relatively
new and less developed. Many NGOs enjoy a special trust of the public, are smaller in their
scope of operation and are often organised in a less hierarchical and administratively rigid
manner, so they are above all more flexible and can often respond to the needs of the
environment faster than larger institutions. At the same time, NGOs are often capable of
better adapting their methods of operation. The role of NGOs in promoting a healthy lifestyle
and health enhancing physical activity is particularly important when strategic partnerships
are formed during the planning and enactment/implementation of the strategies that have been
adopted. In addition to the above, there are numerous and highly important societies/clubs (in
total over 18,000) that are active in health, sport and recreational sport activities, in addition
to other activities, with the membership of over a quarter of the entire population of Slovenia.
Therefore, action plans for achieving the set goals and tasks of promoting health enhancing
physical activities will be based primarily on these societies/clubs (and public institutes).
12
2
PILLARS OF HEALTH ENHANCING PHYSICAL ACTIVITIES
Based on professional findings about synergetic effects of healthy nutrition and health
enhancing physical activity, it is necessary that Slovenia’s strategies for the prevention of
CND in both of these areas are planned and implemented jointly and in a coordinated manner.
Within this framework, health enhancing physical activity is defined as any form of bodily
movement that involves skeletal muscles and results in an expenditure of energy.
Three main pillars of health enhancing physical activity are:
1.
Recreational sports – free time physical activities with their own specific
activity, definition, goals, methods and about which each individual decides freely on
the basis of his/her own desires, needs, interests, motives of pleasure and satisfaction
when it is time to relax, in order to increase one’s physical abilities and to condition
the body in compliance with the existing abilities and available possibilities in the
environment in which an individual lives.
2.
Health Enhancing Physical Activity in the Work or School Environment
(Extracurricular) This is a physical activity for which an individual decides and
performs it on the basis of his/her need to perform health promoting activity and
his/her desire and need to exercise. In this respect, we differentiate between health
enhancing physical activity:
- at work or at school, and
- in the work environment but apart from the work itself, or in the school
environment as extracurricular activities.
3.
Transport-related Health Enhancing Physical Activity These are activities for
which an individual decides as a result of his/her need or wish to meet his/her
transportation demands in daily life. These are mostly the activities whose goal is to
accomplish daily goals of un individual (work, errands, shopping, visits and/or other
obligations).
13
2.1
Professional Definitions, Guidelines and Recommendations on Health Enhancing
Physical Activities
2.1.1 Definition
Physical activity is defined as a variety of individual physical activities including leisure time
activities, activities at or during work as well as all activities performed with the aim to reach
the goals of an individual’s every-day essential and planned activities (commuting to work,
shopping, visiting people and/or performing other duties). It involves various movements of
one's own body with the assistance of skeletal muscles and results in an expenditure of
energy. On the other hand, physical exercise is defined as purposeful physical activity that is
usually structured and is also meant to improve or strengthen health and physical fitness of an
individual. Numerous research studies have shown that adequate physical activity has very
positive effects on the human organism. Regular and moderately intense physical activity
improves physical and mental health and reduces the risk of CND and early morbidity,
mortality and disability caused by CNDs:
- reduces the risk of the development, progression and complications of CNDs;
- strengthens bones and muscles and develops, improves and maintains bodily
psychophysical or functional abilities and, consequently, increases the ability of an
independent life in old age;
- helps to alleviate stress, anxiety and depression;
- improves self-esteem, self-respect and self-confidence;
- helps to establish social interaction and social integration, improves social and
economic wellbeing of an individual, families, communities and the whole nation.
Lack of physical activity or a sedentary lifestyle is a behavioural risk factor, closely related to
various disorders and above all to chronic diseases. On the other hand, an active lifestyle
does not only bring fewer chances of morbidity, but also significantly contributes towards a
general quality of life. It has been proven that regular physical activity of moderate intensity
protects health in all age groups.
2.1.2 Guidelines and Recommendations
When determining what a sufficient and adequate physical activity is to benefit and protect
health, it is important to consider several criteria – the type of physical activity, its intensity,
frequency and duration. In this regard, the amount of regular physical activity and health
benefits are proportionally related. However, it is known that for significant effects on health,
the exercise does not necessarily have to be vigorous – it is enough to be physically active
regularly and moderately. Traditional and new guidelines for individual of the above stated
criteria are mentioned below.
1.
Types of physical activity Traditional recommendations advice predominantly
aerobic rhythmic exercises which involve movement of the large muscular groups and
are sustained for a considerable amount of time (brisk walking, running, cycling,
swimming, ice-skating, cross-country skiing etc.). Newer guidelines recommend and
lay stress on walking or any other physical activity that can be carried out daily with
an intensity similar to brisk walking;
- moderate housework (such as lifting or carrying objects);
14
-
moderately intense gardening;
ball games and other games while walking or slowly running with children,
moderately intense swimming;
slow running (approx. 7 km/h).
It is important that all types of performed physical activity are balanced. The general
recommendation is that the time spent on various types of exercise should be divided
accordingly - 50 % on aerobic exercise, 25 % on flexibility exercises and 25 % on exercises
for muscular strength.
2.
Intensity of physical activity Traditional guidelines advise that the intensity of the
exercise in an individual needs to be 50-85% of individual’s heart rate reserve which
corresponds to 50-85% of the maximum aerobic power (oxygen consumption). In the
majority of adults this means a heart rate frequency of 140-160 beats per minute. The
latest recommendations define (with reference to point one) moderate-intensity
activity at the level of effort equivalent to 3-6 metabolic equivalents (MET) or any
activity that burns 4-7 kcal/min.
3.
Frequency of physical activity Until recently, the guidelines recommended to be
physically active at least three times a week, however, the new guidelines recommend
more and more often daily exercise or physical activity that takes place at least 5
times a week.
4.
Duration of physical activity Traditional recommendations recommend a duration in
the range of 30-60 minutes, the latest guidelines allow intermittent exercise in
several daily sessions or with longer or shorter breaks if the activity cannot be carried
out continuously. The duration of a single session should not be shorter than 10-15
minutes; a total recommended daily duration should be at least 30 minutes.
2.1.3 Summary of Recommendations concerning Physical Activity for Adult
Population
To achieve positive effects (protection, maintenance and/or improvement) of physical activity
on health, a minimum of half an hour of moderate-intensity activity at least five times a week
is sufficient. Moderate-intensity physical activity is defined as activity which leaves the
individual feeling slightly warm and winded (which means that a person is active at the level
of 40-60% of the aerobic capacity and burns 4-7 kcal per minute which is an equivalent to 3.6
MET). The exercise should be as diverse as possible and it can be carried out in various
settings (at home, at work, for transportation purposes), it should be safe (adjusted to age,
health status and physical circumstances), balanced with regard to type (50% of aerobic
exercise, 25% of flexibility exercise and 25% of strength exercise) and it should be enjoyable.
In order to preserve and strengthen health, a zero balance between energy intake and energy
consumption is of utmost importance, or in short between food intake and physical activity.
Healthy nutrition and regular physical activity influence health each one on their own,
however, in a healthy lifestyle due account is being taken of both elements, they produce a
synergic effect.
15
In the text that follows, we briefly summarise the recommendations of nutrition guidelines
(CINDI, WHO), that is healthy lifestyle guidelines, which are based on dietary habits (FBDGFood Based Dietary Guidelines). FBDG must be simple and comprehensible to consumers
and must inform them on how they should nourish themselves in order to preserve and
improve their health. Nutrition guidelines for general population, based on the recommended
dietary pattern and an active lifestyle while also taking into consideration unhealthy dietary
habits in the Republic of Slovenia, are based on 12 steps toward a healthy dietary pattern:
2.1.4 Guidelines on Healthy Dietary Habits Based on a Dietary Model - Food
Based Dietary Guidelines (FBDG):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Enjoy your meal. Choose complete and varied food which should contain more
foodstuffs of vegetable than of animal origin.
Eat bread, pasta, rice and potatoes several times a day.
Consume a variety of vegetables and fruits several times a day (minimum 400 g
daily). Select locally grown, fresh vegetables and fruit.
Be physically active to such an extent that your body weight is normal (IBM
value
should be within the range of 20 to 25).
Control the amounts of consumed fat (not more than 30% of daily energy
intake) and substitute most saturated fats (animal fats) by unsaturated vegetable oils.
Substitute high-fat meat and (fatty) meat products with legumes, fish, poultry- meat
or lean meat.
Consume daily the recommended amounts of reduced-fat milk and lesser amount
of
reduced-fat and salty diary products (yogurt, sour milk, kefir, cheese).
Add moderate amounts of sugar and select foods with reduced sugar content. Limit
the frequency of confectionery intake and consumption of sweet drinks.
Eat less salty food. The daily salt intake should not exceed 1 teaspoonful (6 g) of
salt, including salt consumed with bread, ready-to-eat dishes and conserved
dishes.
If you drink alcohol, do not consume more than 2 units a day (1 unit is 10 g of
alcohol).
Prepare healthy and hygienic food. Suitable methods influencing the reduction of
fat in prepared dishes are: cooking, simmering, baking, or preparation in a
microwave.
Most suitable for infants is exclusive breastfeeding up to six months of age
which shall be followed by an adequate supplementary diet in the first years of life.
(Source: CINDI Dietary Guide WHO Regional Office for Europe, EUR/00/5018028.2000).
16
2.2
Goals of the Strategy in the National Health Enhancing Physical Activity
Programme (2007-2012)
Concrete goals of increased health enhancing physical activity of some target groups of
population of the RS are:
1.
Children and adolescents under 18 years of age:
to increase the proportion of children and adolescents who spend at least 1 hour a day
in some physical activity by 30%;
 to increase the proportion of children and adolescents who walk and/or cycle for the
purpose of transport in their every-day routines by 20%;
 to decrease the proportion of children and adolescents who spend more than 4 hours of
their free time in front of TV or computer screens by 30%;
 to decrease the proportion of overnutrition and obesity among children and
adolescents by 10%.

2.




3.
Adults aged 18 to 65:
to reduce the proportion of physically totally inactive adults by 30%;
to increase the proportion of population which is, in view of expert recommendations,
regularly and sufficiently involved in health protecting and enhancing physical activity
by 20%;
to increase the proportion of adults who mostly walk and/or cycle for the purpose of
transport to work and in their every-day routines by 20%;
to decrease the proportion of adults who spend more than 4 hours of their free time in
front of TV or computer screens by 30%;
Adults aged 65 years and above:
to reduce the proportion of physically totally inactive adults by 20%;
to increase the proportion of persons who are, in view of expert recommendations,
regularly and sufficiently involved in health protecting and enhancing physical activity
by 20%;
 to decrease the proportion of adults who spend more than 4 hours of their free time in
front of TV or computer screens by 20%;
 to provide as many opportunities as possible for participation in various professionally
qualified forms of safe and accessible physical activity which enhances health for the
groups of population with special needs.


4.
Pregnant women
5.
Families
6.
Persons with special needs and workers in the working environment
17
3
3.1
DISEASES ASSOCIATED WITH INSUFFICIENT PHYSICAL ACTIVITY
Life expectancy and premature mortality
In the last decade under study (1987-1996), life expectancy at birth in Slovenia increased by
2.76 years. As compared to the average life expectancy in EU15 countries in 1999, the
Slovenian males fell short of these standards by 2.9 years and females by 0.9 years on average
(Health care reform, Ministry of Health, 2003).
In 2001, as many as 38 % of all deaths were due to cardiovascular diseases, while another 27
% were associated with cancer. These are followed by 13% of deaths due to different causes,
8% due to respiratory diseases, while 7 % of deaths were attributable to gastrointestinal
diseases, injuries and poisonings (Figure 1).
ostali vzroki
13%
Poškodbe,zastrupi
tve
7%
Novotvorbe
27%
Bolezni prebavil
7%
Bolezni dihal
8%
Bolezni obtočil
38%
Figure 1:
Causes of death in Slovenia in 2002, both genders, all age groups (Source:
Institute of Public Health of the Republic of Slovenia.
Premature mortality due to cardiovascular diseases in Slovenia is apparently decreasing
(Figure 2), while life expectancy at birth is increasing. The structure of diseases and causes of
death are influenced by socio-economic conditions and lifestyles.
18
Novotvorbe
Bolezni obtočil
Bolezni dihal
Bolezni prebavil
Poškodbe,zastrupitve
um rli/1000 preb.
1,80
1,60
1,40
1,20
1,00
0,80
0,60
0,40
0,20
0,00
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Figure 2:
3.2
leto sm rti
Age-standardized mortality rates in Slovenia, 20–64 age (Healthcare
Statistical Yearbook, 2002, Institute of Public Health of the Republic of
Slovenia, 2002).
Geographic distribution of age-standardized mortality rates
Despite the fact that in the past few years some specific mortality rates have decreased,
mortality due to cardiovascular diseases and cancer still tends to be higher than in certain
other selected countries Age-standardized mortality rates due to different diseases show a
distinct geographic distribution, the most prominent being the difference between the east and
west parts of Slovenia.
Figure 3:
Age-standardized mortality rates in Slovenia in 2002 by administrative
units (Source: Healthcare Statistical Yearbook, 2002, Institute of Public
Health of the Republic of Slovenia, 2002).
In the East of Slovenia, men die on average 3 years earlier and women 2 years earlier than in
the West. Also, in the east part of Slovenia, regional centres show lower premature mortality
rates than the remaining areas.
19
Age-standardized mortality rates in Slovenia are lower than in Croatia and Norway, but
higher than the mean value in the Scandinavian countries and EU15 member states. In the
period 1987-2002 the most significant decrease was noted in infant mortality rates; a
significant decrease was also observed in the mortality rates of older adults and the elderly.
The distribution of age-specific mortality rates is represented by a curve whose slope is
determined by biological, socio-economic, geographical, climatic and other factors.
Figure 4:
3.3
Age-standardized mortality rates of the population of Slovenia and of
certain selected European countries in the period 1985-2002 (Source:
http://www.who.dk, WHO Europe, HFA Database, June 2004).
Prematurely lost years of potential life
Years of potential life lost prematurely (YPLL) is a measure to ascertain the contributions of
various causes of death to premature mortality. It is also used as an indicator of the social and
economic burden of premature deaths on the society. Thus a premature death is every death
under the age of 65. In diseases where the proportion of YPLL is greater than the proportion
of premature deaths, the burden of premature mortality is high.
This is true, in particular, of suicides as well as traffic and other accidents, while just the
opposite applies to ischemic heart diseases and gastrointestinal and respiratory cancers
(Figure 5).
20
Figure 5:
Prematurely lost years of potential life by Slovenian regions, leading subcategories of premature death causes in 2001 (Source: Health in Slovenia
2001. Institute of Public Health of the Republic of Slovenia, 2003).
Despite the great burden represented by premature deaths in the Republic of Slovenia, the
number of years of potential life lost prematurely due to illnesses and injuries has been
decreasing in the past years (between 1997 and 2001 by approximately 10%). In comparison
to the base year 1997, the number of YPLL in 2001 decreased by 16% owing to injuries and
intoxications, malignant neoplasms and cardiovascular diseases by 5%, and due to all the
remaining causes by 15% less.
The number of YPLL due to gastrointestinal diseases has increased by 10% (Figure 6).
Figure 6:
3.4
Prematurely lost years of potential life (YPLL) due to disease, Slovenia
1997-2001 (Source: Health in Slovenia 2001. Institute of Public Health of
the Republic of Slovenia, 2003).
Chronic non-communicable diseases
3.4.1 Cardiovascular disease
21
The mortality rate due to cardiovascular diseases in the Republic of Slovenia in men and
women is gradually decreasing, but it is still higher than in the EU15 member states. Agestandardized mortality rates due to cardiovascular diseases in the Republic of Slovenia are
lower than in Hungary and the Czech Republic, and higher than mean value of the EU15
member states (Figure 7).
Figure 7:
Standardized premature mortality rates (per 100,000 population) due to
BSO in the Republic of Slovenia and in some EU member-states (age
group 0-64 years, 1999).
CVDs are the leading causes of death in the Slovenian population (almost 40% on average);
after the age of 65, already 57% of deaths are attributable to CVD. Among these, the coronary
heart disease – ischemic heart disease takes the first place. According to the calculated risk of
coronary diseases with regard to individual and group risk factors present in the Republic of
Slovenia, a significant number of the population over the age of 45 are at risk of cardiac
infarction.
With regard to mortality rates due to cardiovascular diseases, the Republic of Slovenia is
clearly divided into the eastern and the western parts. The review of prevalence of these
diseases by regions shows that the incidence is much higher in the areas situated in the eastern
part of the Republic of Slovenia. In a research from year 2001 »Regional health differences
and search of solutions to decrease them« it was established that for each of the observed
diseases with maximum disease prevalence rate, ranked in the first five positions, the eastern
Slovene regions have been altering: Celje, Novo mesto, Ravne na Koroškem, Maribor, and
Murska Sobota. Only in myocardial and brain infarction the Ljubljana region ranks in
between them. The western and the central regions of Slovenia are at the bottom, as regards
the prevalence of these diseases. In the same research, the survey of the prevalence of all
CVDs shows that this pattern of occurrence is even more pronounced. Among the most CVDburdened regions are the regions of Celje and Ravne na Koroškem, these being followed by
the regions of Novo mesto (33.2%), Murska Sobota (32.8%) and Maribor (31.7%). In the
region with the lowest prevalence of cardiovascular diseases, the number of ill persons is
almost twice lower (19.5/100) than in the most affected regions. The prevalence of these
diseases is also lower in other regions of the western and central Slovenia. It is the highest in
the Ljubljana region (28.2%).
22
3.4.2 Cancer
According to the most recent data published by the Cancer Registry of Slovenia, there were
9,058 new cancer cases detected in 2001, of these 4,565 in men and 4,493 in women, the
estimated figures for 2004 being close to 9,500. In the past 11 years (from 1990 to 2001) the
incidence of cancer in the Republic of Slovenia increased by 25% in men, and by 30% in
women, and the mortality rate by 10% in men and by 9% in women. Also, the incidence of
cancer is increasing more rapidly than the mortality because treatment is more successful,
which is evident from the improvement in relative 5-year survival.
On the one hand, increase in the incidence of cancer in the Republic of Slovenia is
attributable to the ageing of the population, which may explain a 12 % increase of incidence
in the male population, and a 20 % increase in the female population in years 1990-2001,
while the remaining 13% in men and 10% in women, on the other, are the result of spreading
of other more or less well-known risk factors influencing the increase in cancer incidence.
Consequently, the efficacy of primary prevention has been reflected in the impact on cancer
incidence, so as the quality of work of the health service (from early detection to specific
treatment) has been reflected in mortality.
Lung cancer ranks in the first place in the male population since 1967, and has substituted
stomach cancer in this position (Figure 8 and 9). In women, breast cancer still takes the first
place with equal proportion as a year earlier (22%); however, the incidence of this disease is
still on the increase. In both genders, there has been an increase in the incidence of colorectal
cancer, malignant melanoma and other skin cancers, as well as of pancreatic cancer and nonHodgkin’s lymphomas. Among other more frequent cancers are: testicular cancer in men and
pulmonary and uterine cancers in women, the incidence of the latter, however, has not been
increasing since 1999. Four - according to the number of new cases – most frequent cancers
in male and female population contribute to as much as 53 % rate of all new cancer cases
(Source: Cancer Registry of Slovenia, 2001. Ljubljana: Institute of Oncology, 2004).
%
0
5
10
15
20
%
25
0
Pljuča
5
15
20
25
16
Dojka
Debelo črevo in danka*
14
Koža
3
Trebušna slinavka
7
Pljuča
6
Mehur
11
Maternično telo
9
Želodec
14
Debelo črevo in danka*
10
Prostata
21
Koža
13
Glava in vrat*
6
Maternični vrat
MOŠKI
4
Želodec
4
3
Jajčnik
4
Maligni melanom
3
Maligni melanom
3
NHL*
3
NHL*
3
Ostalo
10
21
Ostalo
ŽENSKE
23
Among the most frequent malignant diseases in men, leading are those which are lifestylerelated, while with efficient primary prevention their incidence could be lowered: lung cancer
is associated with smoking, while head and neck cancers are associated with smoking and
abuse of alcoholic drinks, colorectal cancers prevailingly with exaggerated consumption of
saturated fats and insufficient intake of vegetables and fruit, and skin cancer with excessive
tanning. Particularly for colon cancer, insufficient physical activity is also a known risk
factor.
23
Also in women among the most frequently observed cancers are those related to unhealthy
lifestyle and bad habits. Similarly as in men, this applies to colorectal cancer and to skin
cancer. Less accessible to primary prevention are hormonal and reproduction factors (age at
menarche and menopause, at first childbirth, and the number of children) which are involved
in the occurrence of breast cancer, although the morbidity of this most common cancer in
women after menopause is also influenced by body weight and physical activity.
3.4.3 Obesity
As in Western Europe, also in Slovenia the excessive body weight is increasingly associated
with all those health problems entailed by overeating and lack of physical activity. As in other
countries of the world, the proportion of overnourished persons in the Republic of Slovenia is
gradually increasing.
The research »Risk factors for noncommunicable diseases in the adult population of the
Republic of Slovenia«, carried out in the year 2001 on the basis of and self-evaluation of
nutrition status, draws attention to the fact that the Republic of Slovenia is also in the middle
of the epidemic of over-nutrition and obesity as is the rest of the developed world – with all
the negative consequences for health and quality of life, and also with all social and economic
sequelae. In the research, nutrition status was assessed by body mass index (BMI), where a
BMI score under 18.5 was interpreted as malnutrition, score between 18.5 – 24.9 as normal
nutrition status, while a BMI score over 25 but under 30 was defined as over-nutrition, and a
score over 30 as obesity. The authors of the research estimate that the proportion of
overnourished Slovenes is 54.6% in total, while 15.0% of the entire population may be
classified as obese. The data obtained show that the proportion of obese population (17.4%) is
higher in the rural residential environment than in the suburbs (15.0%) and urban environment
(11.8%).
The results of other obesity research in Slovenia are slightly different. The mentioned crosscut
studies, carried out in Ljubljana within the WHO CINDI programme during 1990/91, 1996/97
and 2002/03, and on the level of three demonstration regions of Slovenia (Ljubljana as well as
Pomurje and Severna Primorska) during 2003/03, included direct measurement of BMI in the
population under study. According to these studies, the prevalence of overweight (including
obesity) (BMI>25) was 56.6%, 61.6% and 59%. Results of the study »Risk factors for
noncommunicable diseases in the adult population of the Republic of Slovenia« carried out in
2001, assessing the nutrition status by self-evaluation, revealed a somewhat lower rate than
that found in CINDI study (55.1% of overweight). Based on both mentioned studies, it can be
concluded that the actual rate of obesity ranges between 15% and 20%.
3.4.4 Diabetes
According to data from the study »Risk factors for noncommunicable diseases in the adult
population of the Republic of Slovenia« carried out in 2001, the estimated prevalence of
diabetes in the adult population (age group 25-65 years) of the Republic of Slovenia is 4.3%.
Three regions with the highest prevalence of diabetes are Maribor, Celje, and Ljubljana. As it
can be seen from the results of the above research, the prevalence of diabetes is relatively low
24
under and including the age group 40-44 years, while in the elderly it rapidly increases until
the age 60-64 years.
Taking into account that the incidence of type 2 diabetes is rapidly increasing by age, it can be
concluded that the overall prevalence of diabetes in the adult population of Slovenia is
comparable to that in the developed world, i.e. at least 5-6%.
STAROST
SLADKOR NA
BOLEZEN
(DIABETES)
ne
da
Skupaj
Table 1:
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
Skupaj
914
1135
1236
1143
1281
1104
862
968
8643
99,2%
99,7%
98,6%
97,4%
94,6%
94,4%
90,0%
90,7%
95,7%
7
3
17
30
73
66
96
99
391
,8%
,3%
1,4%
2,6%
5,4%
5,6%
10,0%
9,3%
4,3%
921
1138
1253
1173
1354
1170
958
1067
9034
100,0%
100,0%
100,0%
100,0%
100,0%
100,0%
100,0%
100,0%
100,0%
Prevalence of diabetes in the Republic of Slovenia by adult population age
groups (CINDI Slovenia).
3.4.5 Osteoporosis
According to the International classification of diseases (ICD-10), osteoporosis is considered
to be among the five most frequent causes of cutaneous and subcutaneous diseases requiring
outpatient health care in the age group 65 years and older. Presently, there are no exact data
available on the incidence of osteoporosis in the Republic of Slovenia, however, there is a
screening study being carried out in the Slovene population by the Institute of Public Health
of the RS (IPH RS).
As the nutritional habits and lifestyle of the population of the Republic of Slovenia are
comparable to those of the remaining EU15 member-states, a comparable incidence of
osteoporosis may also be expected. Thus, every third woman and every sixth man between the
age of 50 and 80 is supposed to be affected by osteoporosis.
The data for the Republic of Slovenia, available from the Health Statistical Yearbook of
Slovenia, IPH of the RS, where osteoporosis has been followed up as indicator during the
health care out-patient visits in the age of 65 and more, show that approximately 5,800
patients with osteoporosis are detected and treated every year. Among them there are three
times more women than men. Since osteoporosis is a chronic incurable disease, it is presumed
that only in years 2001 to 2004 approximately 23,200 patients with osteoporosis were
detected and treated in out-patient clinics. This information speaks for the presence of
osteoporosis in a patient, even before pathological fractures take place.
In Slovenia, 133 persons die from hip joint fracture every year; 128 (96%) of these are older
than 65 years. Age- and gender-specific mortality rate due to hip joint fracture after 45 years
of age is increasing by age, being higher in women (25.77/100,000 population) than in men
(11.9/100,000 population).
25
800
Moški
Ženske
Št. umrlih / 100.000 m. oz. ž.
700
600
500
400
300
200
100
0
0-4
5-9
10-14 15-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 nad 90
Starost (v letih)
Figure 10:
3.5
Age- and gender-specific mortality due to hip joint fracture, Slovenia,
1997-2001.
Common risk factors for the occurrence of CND
Besides biological risk factors for the occurrence of CVD, neoplasms and diabetes, such as
genetic disposition, gender and age, there are also numerous physiological or biochemical risk
factors responsible for their occurrence, the most important among these being elevated blood
pressure, increased blood cholesterol and blood sugar levels, obesity and unhealthy lifestyle
factors, such as smoking, lack of physical activity, inadequate nutrition, alcohol and stress.
Various chronic diseases have a number of common risk factors; if several of these factors are
present in an individual simultaneously, their effect is not only added, but multiplied. Results
of the mentioned studies that took place in Slovenia within the WHO CINDI programme, and
were carried out in Ljubljana demonstration region during 1990/91, 1996/97 and 2002/03, as
well as in Pomurje and Severna Primorska regions during 2002/03, have shown that the
prevalence of known risk factors for CND in the age group 25-65 years is very high. In the
periods 1990/91 and 1996/97 an increase in the proportion of individuals with present risk
factors was reported, except in the proportion of smokers and overweight and obese
individuals. In the period from 1996/97 to 2002/03, a slight downward trend was observed in
the presence of the mentioned most relevant independent risk factors for CND.
26
Figure 10:
Schematic presentation of common risk factors for chronic noncommunicable diseases (CND).
redno kajenje
25,1
30,4
42,5
56,4
BMI>25
61,6
56,6
72,1
cel. hol. > 5,0
73,9
70
70,8
LDL-hol > 3,0
78,7
66,8
krvni tlak >
140/90
CINDI 90/91 (n=1692)
Figure 11:
3.6
39,6
43,4
37,9
CINDI 96/97 (n=1342)
CINDI 02/03 (n=1372)
Proportion of examinees with different risk factors in the crosscut studies
carried out within WHO CINDI programme in Ljubljana region
(Slovenia) during 1990/91, 1996/97 and 2002/03.
Low level of physical activity – an important risk factor associated with unhealthy
lifestyle in the Slovenian population.
3.6.1 Low level of health enhancing physical activity
3.6.1.1 Children and adolescents
The international survey “HBSC – Health Behaviour in School-aged Children”, carried out in
the year 2001/02, showed that Slovene children aged 11 years are physically active on
average at least one hour a day approximately four days a week (girls 4.2 and boys 4.9 days a
week). The number of days per week when children (aged 13 and 15) are physically active for
at least one hour decreases by age and amounts to 3.7 days in 13 year-olds; for girls 3.7 and
for boys 4.5 days a week, while in 15 year olds it amounts to 3.7 for girls and 4.2 days a week
for boys (WHO, 2004).
A decline in the frequency of physical activity by age seems to be a trend in several European
regions and countries. On the one hand, we notice a downward trend in the number of days in
a week when children and adolescents are physically active (this trend is particularly evident
in girls), while on the other, it is obvious that boys are physically active more often than girls
of the same age. Similar trends apply to the number of hours spent sitting (watching
television, using computer or doing homework); the above mentioned study has shown that in
the age groups of 11-, 13– and 15-year-olds the number of hours spent sitting is the highest in
13-year-old adolescents. However, we cannot simply conclude that a higher number of sitting
hours should be associated with a lower level of participation in physical activity, since the
27
correlation between the frequency of physical activity and the number of hours a day that
young people spend sitting is not significant. The results of the study, carried out in Slovenia,
coincide with the data stated above, indicating that 48% of 10-year-olds (N=351) and 67% of
13-year-olds (N=325) spend sitting four hours or more outside school hours.
Most comprehensive and current data on the state (level) of physical activity in children and
adolescents can be derived from the results of the recent research (TRP – target research
project) “Physical Exercise/Sport Activity for Health”. A population sample of children and
adolescents comprised schoolchildren of the 4th (n=429) and the 7th (n=403) grades of nineyear elementary school, as well as of the 1st, 2nd, 3rd and 5th grades of secondary school
(n=1079) from all parts of Slovenia. The analysis of the status and behavioural style of
children and adolescents has shown a similar trend of modern lifestyle influence as in adults,
a majority of them being insufficiently physically active. Thus, in their leisure time during the
week, 4th grade and 7th grade schoolchildren spend sitting on average almost 4 and 5 hours a
day, respectively. After adding this time to hours spent sitting at school (5 – 6 hours), it turns
out that they spend sitting daily up to 10 hours or longer. On weekends, 4th grade and 7th
grade schoolchildren spend sitting on average 4 and 5.5 hours a day, respectively. In their
leisure time during the week, secondary schoolboys spend sitting full 4 hours and schoolgirls
almost 5 hours daily; on weekends, in the 1st grade both spend sitting as much as 6 hours and
in the 3rd grade 5 hours, while in the 5th grade the time spent sitting is considerably shorter,
i.e. nearly 4 hours daily for boys and 4.5 hours daily for girls.
In their leisure time, slightly less than 60% of 4th grade and 54% of 7th grade pupils are
frequently engaged in sports, while 6.3% of 4th grade and 4.3% of 7th grade pupils never do
any sports. Among the secondary school students of all grades, over 60% of boys are
frequently engaged in sports, while girls do sports only occasionally (50%). The research was
also aimed at establishing in what forms children and adolescents were most actively
involved. It has been found that children and adolescents are physically most active at school,
which implies that they hardly know any extramural activities. Particularly girls are less
active than boys, irrespective of their age and form of activity.
In the same study, children and adolescents in all age groups expressed a relatively high
positive (more than very good) opinion about their current general welfare. As a rule, the
younger the examinees, the more satisfied they are with their general welfare. Thus, the
highest number of schoolboys and schoolgirls claiming satisfaction with their current welfare
is found in the 4th grade. In the 5th grade of secondary school the opinion of schoolboys and
schoolgirls about their current welfare is the worst, however, still better than good on average.
It is interesting to observe the correlation between present welfare and frequency of
engagement in sports activities in 4th grade primary school pupils of both genders. The
greatest number of pupils who are frequently engaged in sports assess their quality of life as
excellent, while the greatest number of those that never do any sports believe that their quality
of life is poor. As to the present health state and physical condition, the 4th grade primary
school pupils who are regularly involved in sports yield significantly better self-assessment
results than their schoolmates who never do any sports.
Although insufficient physical activity in childhood and adolescence cannot be directly
correlated with the presence of disease, it can be associated with certain important risk factors
known to have a long-term potential to contribute towards the onset, progression and further
complications of CND, such as obesity. In the decade between 1983 – 1993, the proportion of
obese pupils has increased drastically (7.7-fold, from the average 0.6% in 1983 to 6.3% in
2003). In the last ten years (1993-2003) the proportion of obese students has increased by 1.3
28
times. An increase in the proportion of obese pupils is also evident in girls (in the period from
1983 to 1993 the proportion increased by 2.6 times, and in the period from 1993 to 2003 by
1.9 times, i.e. from the average 1.45% in 1983 to 7.53% in 2003) (Figures 12 and 113).
Furthermore, in 2003 the proportion of children and adolescents, classified as obese according
to BMI by IOTF standard (International Obesity Task Force), was significantly higher,
particularly in younger age groups. Trends in the changes of BMI value above 30 closely
resemble those in overweight. It was found that 1.8% of girls and 2.2% of boys at the age of
19 were obese.
Debelost - učenci
8
Delež debelih učencev
7
6
5
4
3
2
1
0
7 let 8 let 9 let
10
let
11
let
12
let
13
let
14
let
15
let
16
let
17
let
18
let
19
let
1983
2,1
2,8
2,4
1,9
1,6
1,6
0,9
1,7
1,7
0,8
0,7
0,2
0,5
1993
4,8
4,8
4,5
4,2
3,7
3,7
3,1
2,9
2,2
1,5
1,6
1,4
1,1
2003
6,5
7,3
7,1
6,6
5,9
5,6
5,6
4,6
4,1
2,5
3,1
2,3
2,2
Starost
Figure 12:
Obesity in Slovenian population of children and adolescents, boys (Source:
Strel et al., 2004).
Debelost - učenke
8
Delež debelih učenk
7
6
5
4
3
2
1
0
7
8
9
10
11
12
13
14
15
16
17
18
19
1983
2,4
3
1,9
2,8
1,5
0,9
1,1
1,5
1,3
0,5
0,6
0,6
0,2
1993
5,2
5
4,2
3,5
2,9
2,8
2,3
1,9
1,7
1,5
1,4
1,2
0,8
2003
6,8
7,3
6,5
5,3
4
3,7
2,9
2,6
2,4
2,3
2,2
1,9
1,8
Starost
Figure 13:
Obesity in Slovenian population of children and adolescents, girls (Source:
Strel et al., 2004).
According to the measurements carried out in the years 1983, 1993 and 2003, the greatest
proportion of overweight Slovene population of children (BMI 25-30 kg/m2) was established
in boys at an age of 9-14 years (17-20%), and in girls between 8 and 13 years of age (1619%). This proportion is lower in younger and older age groups. Significantly higher number
of overweight children in 2003 as compared to 1983 requires an in-depth analysis of the life
environment of children in puberty. When explaining the proportion of overweight children
and adolescents it should be taken into account that from the age of 14 on corrections are
required with respect to IOTF defined BMI, since in 2003 BMI was found to have increased –
29
mainly due to a greater muscular mass, and to a lesser extent, due to the subcutaneous adipose
tissue.
General physical fitness of children as well as adolescents is gradually decreasing. In male
examinees, BMI in the overweight range undergoes a gradual increase between the 4 th grade
of primary school when it reaches the value of 18.1, and the 5th grade of secondary school
when it amounts to 24.4. The mean BMI value in girls is slightly below 20; in the 4th grade
their BMI is 18.4 and in the 7th 20.6, while in the secondary school it reaches a value between
20.8 and 21.2.
Overweight and obesity result from excessive food intake and insufficient physical activity.
At this age, physical activity is both a natural need of the child and a counterbalance to the
passive lifestyle. Besides, this is an optimum age for developing basic physical exercise
programs, children not only develop their motor and functional skills but also their intellectual
potential.
Particularly interesting are the reasons for being involved in physical activities for health as
seen by children and adolescents themselves. For adults perhaps unexpected, in the first place
they claim reasons that are not directly associated with health, improvement of physical
fitness and body strengthening. Their priorities are with social motifs as well as factors of
self-perception, fun and relaxation.
3.6.1.2 Adult population
The "Health-Related Lifestyle" study (2001), which evaluated total physical activity (leisuretime as well as housekeeping chores and occupational activity), discovered in the age group
25-64 at least 20% of people who are not active enough to achieve basic health protection. An
even worse picture emerged from the study on sports-recreational activity (2000) which
revealed that nearly 60% of the Slovene adult population is inactive in sports, slightly less
than a quarter is active occasionally and much less than one fifth is active regularly, at least
twice a week. The study by Petrović et al. showed that the number of people who were not
active in any sports, oscillated in a 20-year period (1978-1998) over a range of 10% and
stabilized below 50%. According to some data, in the 1990’s the situation has even worsened
as the level of physical activity among the adult population decreased. Two cross sectional
studies, carried out in Ljubljana within the framework of the World Health Organisation’s
CINDI Programme in the 1990’s, showed that in the field of physical activity only one third
of the adult population are sufficiently active to protect their health. In the period from 19901997, the proportion of marginally active population decreased to 40%, mainly due to the
increased proportion of physically totally inactive population from 15% to 25%.
The comparison of data obtained in the period between the years 1998 and 2000 shows great
disparities between regular and occasional involvement of the Slovene population in sportsrecreational activities. In regular, organized physical activity, the number of participants
declined by 5.3% and in regular non-organized physical activity by 7.6%. Alarming is the
data from the year 2000, which shows that the proportion of the population that is inactive in
sports, has exceeded 50% (55.4%). Gender-related disparities in physical activity show that in
the year 2000, 44.1% of males and 63.2% of females were physically inactive. Most females
were physically active once weekly. ; the proportion of these amounted to 11.1%, while the
proportion of those who were physically active 4-6 times weekly was the lowest – 1.7%.
Among males, 15.5% participated in physical activities once a week and 12% 2-3 times a
30
week. According to the results, involvement in physical activity declines by age. Regularly
active were 15.3% of those aged 31-41 years, 11.6% of those aged 51-60 years and only 7.6%
of those above 60 years of age. Obvious decline thresholds were recorded after the age of 50
and 60. The involvement in physical activities was greater among the population with higher
education.
As to health promotion and protection related physical activity, current and comprehensive
data are also available for adult population; these were obtained within the framework of the
joint research work on CINDI Slovenia 2002/03 project and the targeted research project
“Physical Exercise/Sports Activity for Health”, which encompassed 2274 adult inhabitants of
Slovenia who participated by responding to questionnaires and attending clinical
examinations, while 871 examinees participated in physical aptitude tests. The analysis of
physical activity of all the respondents participating in this study has shown that 32.4% of
adult Slovene population in the age group 25-64 years are sufficiently physically active to
protect their health (at least 30 minutes of walking or moderate to intense physical activity 5
and more times a week). On the other side of the spectrum, there are 16.0% of adult
Slovenians who are not physically active at all. Minimally physically active are 36.7% of
them; marginally active in terms of health protection are 15.1% of adults.
When comparing the results according to the studied categories of physical activity in the
region of Ljubljana (whose population was involved in the CINDI Ljubljana research in
1990/91 and 1996/97), it becomes evident that the situation in the area of adult physical
activities has changed for the better during the last six years.
45,0
40,0
36,7
35,0
32,1
30,0
25,0
%
20,0
16,0
15,1
15,0
10,0
5,0
0,0
VSI ANKETIRANCI
KOLIČINA TELESNE DEJAVNOSTI V PROSTEM ČASU IN ZDRAVJE
nič teles ne dejavnos ti
m inim alna teles na dejavnos t
m ejno zados tna teles na dejavnos t za zaš čito zdravja
zados tna teles na dejavnos t za zaš čito zdravja
Figure 14:
Physical exercise/sports activity in adult population of Slovenia (Source:
TRP “Physical exercise/sports activity for health).
It is encouraging to note that, recently, the so-far persistent significant difference in the
frequency of health enhancing physical activity between genders has practically disappeared –
here it needs to be pointed out that the proportion of females regularly involved in a moderate
to intense physical activity has increased significantly.
31
Another very important finding refers to the proportion of physically sufficiently active
population – in terms of health protection – by age groups.
Here we note a gradual decrease in the proportion of regularly physically active population in
30 – 50 year age group, which could be explained by the fact that this is the period of life
when adults are mainly preoccupied with providing material goods or making career, and thus
unable or unwilling to find some spare time for leisure physical activities. The proportion of
population regularly involved in moderate to intense physical activity starts to increase after
the age of 50, which might be attributable to changing values (care for a better quality of life
or health in a narrower sense of the word). The study has reconfirmed that the proportion of
population physically active in their leisure time is higher in urban environment than in the
rural environment and suburbs.
45,0
38,7
40,0
35,0
35,0
32,4
31,9
30,0
25,0
%
20,0
16,9
16,1
15,9
13,1
15,0
10,0
5,0
0,0
m oš ki
žens ke
SPOL
KOLIČINA TELESNE DEJAVNOSTI V PROSTEM ČASU IN ZDRAVJE
nič teles ne dejavnos ti
m inim alna teles na dejavnos t
m ejno zados tna teles na dejavnos t za zaš čito zdravja
zados tna teles na dejavnos t za zaš čito zdravja
Figure 15:
Physical exercise/sports activity in adult population of Slovenia (Source:
TRP “Physical exercise/sports activity for health).
50,0
45,0
42,4
41,3
40,0
38,3
40,0
35,6
34,6
35,0
30,9
29,1
30,0
27,9
26,9
% 25,0
20,0
15,0
15,4
16,8
15,6
15,4
17,5
16,9
16,5
15,3
12,9
10,6
10,0
5,0
0,0
25-29
30-39
40-49
50-59
60-64
STAROST
KOLIČINA TELESNE DEJAVNOSTI V PROSTEM ČASU IN ZDRAVJE
Figure 16:
nič telesne dejavnosti
minimalna telesna dejavnost
mejno zadostna telesna dejavnost za zaščito zdravja
zadostna telesna dejavnost za zaščito zdravja
Physical exercise/sports activity in adult population of Slovenia by age
groups (Source: TRP “Physical exercise/sports activity for health”).
More relevant in terms of public health situation in Slovenia and more encouraging are the
results of the analysis of physical exercise/sports activity in leisure time, which show that
32
actually as much as 47,3 %, and occasionally additional 42,3 %, of the Slovene adult
population participates in at least one type of physical activity. It must be emphasised,
however, that the greatest number of regularly as well as occasionally active persons are
found in the category of non-organised activities, when they actually see to their physical
activity by themselves. The proportion of population participating in various forms of
organised physical activities (in sports clubs, societies, either under private ownership or
within a work organisation) is relatively small.
Based on the results of the present study, it can be concluded generally that regular and
sufficient leisure time physical activity in the adult Slovenian population is associated with
better health indicators. Persons under study, who were considered sufficiently active
according to the certain internationally accepted health protection criteria, were found to be
less frequently exposed to individual risk factors and were at an overall lower risk of
contracting a manifest CVD in the near future.
Among the examinees with hypertension persons who never practise any form of physical
activity (57.1%) are prevailing, whereas physically active examinees present with arterial
hypertension in a significantly lower percentage (38.9% in the group occasionally active in at
least one form, and 36.6% in the group regularly active in at least one form). The result
indicates that, in order to reduce the occurrence of atrial hypertension, even an occasional
physical activity in at least one form may already be sufficient. Similar results applies to the
value of total serum cholesterol. Among persons with elevated cholesterol values those who
are not active in any form of physical activity are prevailing (76.6%); the proportion of
persons with elevated total serum cholesterol among those occasionally active in at least one
form is 76.6%, the proportion being the lowest among those who are regularly active (72.1%).
Significant differences as regards the frequency of physical activity can also be noted among
persons with increased BMI (25.0 kg/m2 and more). The proportion of obese persons is the
highest (31.1%) among those who are not physically active in any form, while it is
significantly lower among those who are occasionally active in at least one form (21.5%), and
the lowest in the group of persons that are regularly active in at least one form (17.2%).
Among the examinees falling within the category with high coronary risk (20% and higher
probability of manifest coronary disease occurrence in next 10 years) there are altogether
29.7% of those who never practise any form of physical activity, 15.1% who are active
occasionally in at least one form, and 14.8% who are regularly active in at least one form. On
the other hand, a high rate of occasionally active (57.6%) or regularly active (57.8%) persons
can be found among the examinees at a low risk for the occurrence of manifest coronary
disease in near future. In order to reduce the risk of CVD occurrence, even an occasional
physical activity in at least one form seems to be relevant.
3.6.1.3 Persons aged 65 years and above
In Slovenia, there is a lack of research on the situation in the field of regular physical activity
among people over the age of 65 years. The majority of studies and surveys include only
participants aged 25-65 years. The "Health-related Lifestyle" study showed that physical
inactivity decreases by age, although the only statistically significant decrease was recorded
in the age groups 40-49 and 50-59 years.
Also the results of the Slovene Public Opinion study have shown that participation rates in
physical activities are higher among the young generation. From the point of view of the
33
longitudinal monitoring, consecutive studies in the last three decades have shown a distinctly
increasing trend in the proportion of physically inactive population by age and a typical turn
towards inactivity after the age of 60. In the period from 1989 to 1997 the proportion of
inactive population after that age persisted to be slightly below 75%.
An active lifestyle, which does not necessarily involve physical or recreational activities,
reduces the risk of disease occurrence and/or disease related severe complications, and
improves the general quality of life of an individual as well as of larger population groups of
all ages. This particularly applies to the older generation, as it is very important to reduce the
number of dependent elderly people and to increase the number of those who are able to have
an independent, quality life and increased longevity.
3.6.1.4 Pregnant women
Women of new generation also want to maintain their physical fitness during pregnancy and
spend this period in a natural way, within the limits of the physiological adaptations of the
body to pregnancy and without any risks to the baby’s health. Although scientific evidence is
in favour of physical activity being maintained during pregnancy, health and sports
professionals are often sceptical when advising and prescribing a suitable type of physical
activity to pregnant women. It is often the case that they simply want to avoid the risk of
advising pregnant women to be active and therefore simply dissuade them from physical
activity. In Slovenia, exercising during pregnancy is carried out by various profiles: health
workers, sports educators as well as laymen. Most of them are not qualified to conduct
programmes for pregnant women, since this requires understanding of the anatomic and
physiological changes during pregnancy, knowledge of identifying health problems and their
symptoms as well as experience in prescribing and modifying the exercise routine. In
developed countries, licences for conducting programmes for pregnant women can be
obtained through postgraduate studies, which are under governmental supervision.
3.7
Characteristics of the most threatened population groups due to unhealthy lifestyle
Health-threatened groups of the Slovene population due to unhealthy lifestyle are best defined
by the results of a review crosscut study »Health-Related Lifestyle«, performed in year 2001
on a representative sample of over 15,000 adult Slovenes. Behavioural risks found in this
study have been associated with age, education, employment, social class (with regard to
definition itself), residential environment and geographic area of the examinees’ residence.
The results show that due to unhealthy nutrition, which endangers the health of the population
in general, the following population subgroups are at higher risk than average:
- – men,
- at an age from 25-49 years,
- of lower education level (with maximum completed 2-3-year vocational
school),
- actively employed,
- from the lower social class,
- rural residents, and
- residents of the eastern Slovene health region.
34
Due to insufficient physical activity (the study accounted for all types of physical activities,
even those at work), which endangers health, the following population subgroups are at
higher risk than average:
- women;
- age group 25-49 years;
- with completed at least four-year secondary school education or grammar school,
- actively employed,
- from the lower social class on the one hand and the middle and upper-middle class
on the other;
- residents of cities and suburbs;
- residents of western and central parts of Slovenia.
3.8
Summary of key problems in the field of health enhancing physical activity in
Slovenia
-
too high a proportion of physically inactive population in all age groups;
longer time spent by the population of all age groups in front of the television or a
computer;
too low a proportion of population that for the purpose of transport in their everyday routines walk and/or ride a bicycle;
an insufficient awareness of the population of the importance of regular health
enhancing physical activity in all periods of life.
lacking infrastructure for safe performance of physical activity;
shortage of attractive health enhancing physical activity programs.
35
GOALS AND STRATEGIES IN THE PROMOTION OF A HEALTHY LIFESTYLE
WITH AN EMPHASIS ON HEALTH ENHANCING PHYSICAL ACTIVITIES
3.9
The Promotion of Health Enhancing Physical Activity Field
3.9.1 6.1.1 Strategic Aims of the Field
-
-
establish the culture of health enhancing physical activities in all population
groups, especially with regards to children and adolescents of Slovenia;
promote health enhancing physical activity for all age groups of the Slovene
population and for groups with special needs while taking into consideration their
current health status;
provide accessibility and conditions for the implementation of safe, effective and
pleasant health enhancing physical activity in residential, tourist and other
environments.
The basic strategic aims are the foundation for setting concrete tasks for the projects of action
plan preparation within the scope of the national programme, and these tasks are:
- strengthening the values, awareness and knowledge of the entire population with
regard to physical activities that enhance health, irrespective of their age, gender,
educational level, socio-economic status, the functioning of the locomotory system
and other factors;
- implementing consistently the recommendations on health enhancing physical
activities;
- ensuring competent planning, coordination and implementation of activities and
projects regarding physical activities in public interest – in the field of educational,
research, media and action projects, in addition to providing accessibility, quality
and safe exercise, maintenance of sport facilities, etc.
- establishing links and cooperation of medical and sport professions and of science
in stimulating the population to participate in regular and systematic physical
activities;
- making it possible for health enhancing physical activity to become a component
part of occupational policies in all groups of the civil society;
- increasing accessibility and quality of recreational activities, and providing the
possibility to choose;
- providing professionally elaborated programmes of health promoting physical
activities for work and living environments;
- strengthening the promotion of health enhancing physical activities in the health
care system, in training and education, in work environments, and in local
communities;
- strengthening the system of continuous monitoring and evaluation of the situation
regarding health enhancing physical activities, and the activities regarding full
quality assurance in this field in Slovenia.
36
3.9.2 Strategies for establishing and upgrading a healthy lifestyle with an emphasis on
health enhancing physical activities of individual target groups
3.9.2.1 Children and adolescents
GOALS
Foster the culture of health
enhancing physical activity
with children and
adolescents
Motivate children and
adolescents to participate in
regular physical education
classes and to become
involved in various free
time recreational activities
TASKS AND ACTIVITIES
Establish and implement
promotional measures for healthy
dietary habits of children and
adolescents, as well as parents, in
the media, schools, student
residence halls and local
communities
TASK PERFORMERS
MINISTRIESRE
SPONSIBLE
Ministry
Mass media
responsible for
health
Institute of Public Health
of the RS
Regional health care
institutes
CINDI Slovenia
Introduce or upgrade the subject
matter of health enhancing physical
activities and a healthy lifestyle in
the curricula of primary schools,
vocational and secondary schools,
and in undergraduate studies of
Reach the goal that children pedagogical and health professions
and adolescents are
physically active at least
Formulate and systematically
one hour a day
implement continuous education in
healthy nutrition and healthy
lifestyle subjects for teachers and
staff in kindergartens and schools
Ministry
responsible for
education and
sport
National Education
Institute of the RS
Faculties of Education
Faculty of Physical
Education
Both faculties of
medicine
Colleges of health
studies
Teachers of physical
education and other
teachers
Health services and
health education
providers
Municipalities and local
communities
Societies/clubs and
associations
37
3.9.2.2 Adults
3.9.2.2.1 Promotion of Health Enhancing Physical Activity for Adult Population
GOALS
Strengthen the values,
information and
knowledge of all
inhabitants with regard to
health enhancing physical
activity and recreation
Increase the proportion of
the population that
participates in regular
physical activities or
reduce the prevalence of
a sedentary lifestyle
Enforce
recommendations for
health enhancing physical
activity
TASKS AND
ACTIVITIES
Develop and promote
recommendations for
health enhancing physical
activities
Strengthen the
knowledge, skills,
awareness and motivation
of the population in
connection with health
enhancing physical
activity
Provide information on
possibilities for physical
activity in residential
environments
Intensify advisory
activities on changing a
lifestyle through healthy
lifestyle workshops
taking place in health
education centres within
the scope of national
primary prevention
programmes on CVDs
and other chronic
diseases
MINISTRIES
RESPONSIBLE
Ministry responsible for
health
Ministry responsible for
education and sport
Ministry responsible for
the environment and
spatial planning
Ministry responsible for
the economy
Ministry responsible for
regional development and
local self-government
Ministry responsible for
agriculture, forestry and
food
TASK PERFORMERS
Department for the
promotion of health and a
healthy lifestyle
Institute of Public Health
of the RS
Regional health care
institutes
CINDI Slovenia
Health service and health
education providers
Institute for Sports of the
RS
Chamber of Agriculture
and Forestry of Slovenia
Agricultural advisory
services
Mass media
Various sport
societies/clubs
and national associations
Expand the
implementation of health
enhancing physical
activity programmes
based on the experience
from the pilot project
"Lead a healthy life” into
all Slovene environments
Local communities
Prepare action
programmes for
individual subgroups of
the adult population
(according to gender, age,
education and the type of
living environment)
38
3.9.2.3 Population aged 65 years and above
3.9.2.3.1 Development, promotion, implementation and evaluation of physical activity
programmes for the older population
GOALS
Increase the ability to function
and the quality of life of the
population aged 65 and above
Increase the proportion of the
population aged 65 and above
that are involved in physical
activity programmes
(individual and group
programmes)
Offer quality programmes of
physical activity for individual
groups of the elderly in
compliance with their needs
and abilities
Train professional staff and
laymen for a quality
implementation of physical
activity programmes for the
elderly
MINISTRIES
TASK PERFORMERS
RESPONSIBLE
Establish a national body with Ministry
Slovenian Federation of
a professional team to develop responsible for
Pensioners' Organisations
guidelines for the preparation health
and other societies and
of physical activity
associations
programmes for the elderly
Ministry
and to supervise their content responsible for
Association of Social
and implementation
labour, family
Institutes
and social affairs of Slovenia
Establish educational and
training facilities in the health Ministry
Gerontological Society
education centres at the
responsible for
primary health care centres
education and
CINDI Slovenia
sport
Implementation of the
Health care service
programmes for improving
Ministry
providers
physical abilities of the
responsible for
elderly in health education
the environment Primary Health Care
centres at the primary health
and spatial
Centres
care centres and at the homes planning
for the elderly
Health Education Centres
for groups aged 65 and above Ministry
with reduced physical abilities responsible for
Homes for the Elderly
regional
Establishment of local centres development and Local communities
for organised physical
local selfactivities including the setting government
Insurance agencies
up of information network
Society of Physiotherapists
of Slovenia
TASKS AND ACTIVITIES
Colleges of health studies
39
3.9.2.4 Pregnant Women
3.9.2.4.1 Promotion, Development and Implementation of Health Enhancing Physical
Activities for Pregnant Women – “Fit” Pregnant Women
GOALS
TASKS AND ACTIVITIES
Provide a modern and
accessible programme of
physical activities for
pregnant women at the
national level
Influence a better outcome of
pregnancy and childbirth and
indirectly, via the mother, the
health of the foetus
Reduce pregnancy-related
disease risk factors and
consequently the cost of
health and social security
Influence a healthy lifestyle
of young families
Promotion of physical activity
during pregnancy
MINISTRIES
TASK PERFORMERS
RESPONSIBLE
Ministry
Expanded professional
responsible for
collegium of
health
gynaecologists
Provide a uniform and accessible
“Fit pregnant women” programme
at the national level
Educate and train staff to manage
physical activity during pregnancy
at the undergraduate and graduate
levels
Expanded professional
collegium of
physiotherapists
Ministry
responsible for
education and
sport
Prepare standards for institutions
willing to organise such exercises,
provide supervision of professional
competence in the management and
organisation of physical activities
for pregnant women
Separate the programmes of
physical activity for healthy and ill
pregnant women
Include into the curricula of the
school for future parents the
development of habits involving
health enhancing physical activities
Society of
Physiotherapists of
Slovenia
The Midwifery Society
of Slovenia
Both faculties of
medicine
Colleges of health
studies
Health care institutions
(hospitals, primary
health care and health
education centres,
health resorts) and
providers of health care
service
The Health Insurance
Institute of Slovenia
3.9.2.5 Families
3.9.2.5.1 Promotion, Development and Implementation of Physical Activity
Programmes for Families
GOALS
Increase the
awareness and
knowledge of the
significance of
regular physical
activity for the
health of
individuals and
families
TASKS AND
ACTIVITIES
Develop “messages of role
models” and attract the
participation of known
persons/opinion-makers
regarding the commitment
to a healthy lifestyle
MINISTRIES
RESPONSIBLE
Ministry responsible for
health
TASK PERFORMERS
Both faculties of medicine
Faculties of Education
Ministry responsible for
education and sport
Faculty of Physical Education
Colleges of health studies
Promote physical activity
within the scope of
professional activities of
paediatricians and school
and family medical
Ministry responsible for
the environment and
spatial planning
40
CINDI Slovenia
Institute of Public Health of the
RS
services
Improve the
possibilities for
family
involvement in
health enhancing
physical activity
programmes
Promote active
transportation of
all family
members (to
work, school,
recreation walking, cycling)
Ministry responsible for
the economy
Upgrade the
undergraduate and
graduate studies of general
practitioners and their staff
on theoretical and practical
levels regarding the
promotion of a healthy
lifestyle and health
enhancing physical
activity
The ministry responsible
for regional
development and local
self-government
Regional health care institutes
Associations/Chairs of
general/family medicine,
paediatrics and school medicine
Sporting-cultural organisations
and societies
Health insurance agencies
Local communities
Develop family
programmes that are
attractive and accessible in
terms of their price and
location
Child-care and educational
institutions (nurseries,
kindergartens and schools)
Promote active
transportation to work,
school, recreation
(walking, cycling)
3.9.2.6 Persons with Special Needs
3.9.2.6.1 Promotion, Development and Implementation of Physical Activity
Programmes for Persons with Special Needs
GOALS
TASKS AND ACTIVITIES
Increase the awareness
and knowledge of
persons with special
needs on the
significance of physical
activity and a healthy
lifestyle
Establish a national body with a
professional collegiate for the
preparation and implementation of
a sub-project on physical activities
for persons with special needs
Prepare and upgrade or update the
programmes of health enhancing
physical activity
Motivate persons with
special needs, and
health, sport and
education staff for the
implementation of a
modern and safe
concept of physical
activity in Slovenia
Provide adequate
education and training
of personnel for the
implementation of
physical activity
programmes for persons
with special needs
Promotion of regular physical
activity for persons with special
needs
Coordinate and make uniform the
education of personnel for the
management of the teaching
process in practice
Continuous education and
evaluation of personnel
responsible for the management of
physical activity programmes for
persons with special needs
Offer a wider choice of
quality and accessible
41
MINISTRIES
RESPONSIBLE
Ministry responsible for
health
TASK
PERFORMERS
Disability
organisations and
societies
Ministry responsible for
labour, family and
social affairs
Institutions for
persons with
special needs
Ministry responsible for
education and sport
Association of
Social Institutes of
Slovenia
Society of
Physiotherapists of
Slovenia
Medical
institutions
(hospitals,
primary health care
centres, health
resorts
physical activity
programmes for persons
with special needs
3.9.2.7 Promotion of education and training of professional personnel from the tourist
sector in healthy lifestyles and health enhancing physical activity in tourist
environments
GOALS
Provide adequate
knowledge to tourist
workers and other
professional workers in
tourism concerning
health enhancing
physical activity and
healthy lifestyle
Introduce a new study
programme and the
occupation of "health
promoter" in tourism
TASKS
Promote or update the subject
matter on the role of a healthy
lifestyle and health enhancing
physical activities, including
their various options, in the
curricula of tourist branch
schools
Implement the programmes of
continuous education on a
healthy lifestyle and health
enhancing physical activity for
health promoters in tourism
Prepare and introduce a new
study programme and the
occupation of "health promoter"
in tourism
MINISTRIES
RESPONSIBLE
Ministry
responsible for
health
Ministry
responsible for
education and
sport
Ministry
responsible for
higher education
and science
Ministry
responsible for
the economy
TASK PERFORMERS
Centre for Vocational Training
CINDI Slovenia
Institute of Public Health of the
RS
Regional health care institutes
Secondary schools, colleges
and higher education
institutions for catering and
tourism
Chamber of Commerce and
Industry of Slovenia
Tourist Workers Chamber
Faculty of Physical Education
3.9.2.8 Introduction of a licensing system for advisors and providers of health
enhancing physical activities
GOALS
Providing a suitable
professional level of
extracurricular health
activities (outside the
formal school system)
TASKS
Introduction of a licensing system for
advisors and providers of health
enhancing physical activities
MINISTRIES
RESPONSIBLE
Ministry
responsible for
health
TASK PERFORMERS
Faculty of Physical
Education
CINDI Slovenia
Faculties of education
Colleges of health
studies
42
3.9.3 Strategy for increased accessibility and quality of health enhancing physical
activities
3.9.3.1 Improved offer of quality programmes in health enhancing physical activities
GOALS
Greater offer of
quality, safe and
widely accessible
programmes of
health enhancing
physical activity
aiming to instil an
active lifestyle
Provide quality
infrastructure,
services and other
facilities in support
of mass recreation
activities
TASKS
MINISTRIES
RESPONSIBLE
Develop the guidelines for new
systemic or legislative solutions
allowing accessible and
satisfactory provision of health
enhancing physical activities to
all
Develop the guidelines for the
preparation of programmes for
various target groups in
compliance with their needs and
abilities
TASK PERFORMERS
Ministry
responsible for
health
Faculty of Physical Education
Ministry
responsible for
education and
sport
Regional health care institutes
Institute of Public Health of the
RS
CINDI Slovenia
Colleges of health studies
Faculty of Education
Develop quality standards for
those institutions that will
implement physical activity
programmes
Both faculties of medicine
Establish control over
professional competence of
managerial work
Establish an information network
on physical activity programmes
Establish a register of providers
of physical activity programmes
Develop a modular/certification
system of education for the
providers of physical activities so
they may advance their
knowledge
Provide continuous training and
advanced training and testing of
personnel for the management of
physical activity programmes
Extend the offer of
programmes for
daily physical
activity of children
and adolescents
Implement a pilot project on a
Ministry
national programme for the
responsible for
promotion of health enhancing
health
physical activity in model
schools and kindergartens (6
primary schools, 6 kindergartens,
4 secondary schools)
Physical education teachers
Institute of Public Health
of Slovenia
Institute of Sport of the RS
Develop and implement model
cooperation between physical
education teachers and general
practitioners
National Institute of Sport of the
RS
43
Develop attractive syllabi of
physical education and additional
programmes of health enhancing
physical activity aiming to instil
an active lifestyle into children
and adolescents
Introduce a national programme
of health enhancing physical
activities into all primary and
secondary schools, and
kindergartens
Prepare a common information
system for monitoring the health
and physical activity status of
children and adolescents
Strengthen the
network of local
providers of
organised physical
activity (societies,
clubs, etc.)
Systemic support to local
providers of organised health
enhancing physical activity
Ministry
responsible for
health
Olympic Committee of Slovenia,
and sport associations
Sport Union of Slovenia
Expert coordination of provided Ministry
(non) organised health enhancing responsible for
physical activity
education and
sport
Institute of Sport of the RS
3.10 Physical Activity in the Work Environment
3.10.1 Strategic goals of the field
3.10.1.1 Establish the culture of health enhancing physical activities during work and
expand their programmes into work environments
-
-
enhance a positive attitude of the management and workers in companies, their
level of information and knowledge about the importance of a healthy lifestyle and
physical activity during work in order to maintain and improve their health, wellbeing and increase work effectiveness;
transfer the examples of good practice from the promotion of health at work and in
the working environment projects into Slovene companies;
44
3.10.2 Health enhancing physical activity strategies in the working environment
3.10.2.1 Promotion, development and implementation of health and physical activity
promotion programmes for workers
GOALS
TASKS
Develop the awareness of
employees and employers
on the importance of a
healthy lifestyle and health
enhancing physical activity
for creativity and
productivity
Prepare the content and the
implementation plan of the
health promoting
programme for workers
entitled “Fit for work”
Introduce a healthy lifestyle
and health enhancing
physical activity into
companies (during work
and outside work) and
promote examples of good
practice
Decrease the number of
accidents at work
and the incidence of sickleave
MINISTRIES
RESPONSIBLE
Carry out a promotion
campaign “Fit for work”
Carry out a pilot project in
interested companies
Prepare a co-financing
programme for the
promotion of health and
health enhancing physical
activities in companies
Implement the programme
“Fit for work” in interested
companies
Reduce work-related
disability, the incidence of
occupational diseases and
morbidity related to work
and unhealthy lifestyle
TASK PERFORMERS
Ministry
responsible for
health
Clinical Institute of
Occupational Medicine, the
Sports and Transport Medicine
Ministry
responsible for
labour, family
and social
affairs
CINDI Slovenia
Institute of Public Health of the
RS
Regional health care institutes
Ministry
responsible for
the economy
Health Education Centres
Chamber of Commerce and
Industry of Slovenia
Employers’ Association of the
RS
Chamber of Craft of Slovenia
Trade unions
45
3.11 The Field of Transport-Related Health Enhancing Physical Activity
3.11.1 Strategic goals of the field
3.11.1.1 Establish the culture of health enhancing physical activity related to
transportation in all population groups and provide conditions for safe walking
and cycling
-
adapt spatial plans and develop urban areas in a way that reduces the need for car
travel and shortens individual trails;
establish conditions for urban planners and operators of public transport which
allow them to combine public transport with walking and cycling;
provide new or improved transport infrastructure which includes cycling and
walking trails;
provide adequate parking space for bicycles;
develop appropriate public and promotional measures.
46
3.11.2 Strategies for increasing active transportation modes to enhance health
3.11.2.1 Promotion of transportation modes involving health enhancing physical activity
and improvement of traffic infrastructure for pedestrians and cyclists
GOALS
TASKS AND ACTIVITIES
Increase the
proportion of active
participants
(pedestrians and
cyclists) in traffic
Adapt spatial plans and develop
urban areas in a way that reduces
the need for car travel and
shortens individual trails
Ensure conditions
for a safe, effective
and pleasant traffic
of pedestrians and
cyclists
Establish conditions for urban
planners and operators of public
transport which allow them to
combine public transport with
walking and cycling
MINISTRIES
RESPONSIBLE
Ministry responsible for
transport
Ministry responsible for
health
Ministry responsible for the
environment and spatial
planning
Ministry responsible for
regional development and
local self-government
Provide new or improved
transport infrastructure which
includes cycling and walking
trails
Ministry responsible for
public administration
Provide adequate parking space
for bicycles
Ensure conditions for a safe,
effective and pleasant traffic of
pedestrians and cyclists
47
Local communities
TASK
PERFORMERS
Directorate of the
Republic of
Slovenia for Roads
Local communities
Institutes for the
environment
Working
organisations
Regional health care
institutes
CINDI Slovenia
4
PROGRAMME EVALUATION AND HEALTH INDICATORS
GOALS
Define indicators for the
monitoring and evaluation of
promotional strategies for
health enhancing physical
activity
Improve the collection and
upgrade internationally
comparable plans for data
collection
TASKS
MINISTRIES
RESPONSIBLE
Determine international and country Ministry responsible
specific indicators in the Republic of for health
Slovenia concerning health
enhancing physical activity
Ministry responsible
Improve the organisation of sectoral for education and
and inter sectoral data collection for sport
the indicators of the implementation
of strategies which promote health
enhancing physical activity
Ministry responsible
(Statistical Health Panel)
for higher education
Link the system of data collection
and science
on health enhancing physical
activity with an internationally
comparable system
Cost/benefit analysis of
strategies and action plans for Establish cost/benefit analyses in the
the promotion of a healthy
implementation of individual
lifestyle and health enhancing strategies and action plans
physical activity
Provide an information system of
providers of health enhancing
physical activities which is
accessible to both the professional
and lay public
Organise the collection of data for
the establishment and follow-up of
health indicators concerning health
enhancing physical activity
Update and maintain the information
system for fundamental areas of
health enhancing physical activity in
Slovenia
48
TASK
PERFORMERS
Statistical Office
of the Republic of
Slovenia.
Institute of Public
Health of the RS
CINDI Slovenia
Faculties
Institute for sport
Providers
of health
enhancing
physical activities