Guide pour la promotion de l’activité physique et la lutte contre les comportements sédentaires

Objectives

The guide establishes a national primary-care framework to promote physical activity and active lifestyles, reduce physical inactivity and sedentary behaviour, and prevent and manage non-communicable diseases in Morocco. It supports the National Multisectoral Strategy for the Prevention and Control of Non-Communicable Diseases 2019–2029, particularly its healthy-lifestyles and prevention area.[1][2][3]

• Promote physical activity across the life course and for people with differing health conditions, abilities, ages and circumstances, adapting recommendations to individual needs.[3]
• Prevent non-communicable diseases and reduce their complications, progression, recurrence, premature mortality and associated health-system burden through primary, secondary and tertiary prevention.[2][4][5]
• Address physical inactivity and sedentary behaviour as distinct health risks, while recognising physical activity as a protective factor for physical, mental, cognitive and social well-being.[6][7][8]
• Integrate adapted physical activity into prevention and care for cardiovascular disease, cancer, obesity, type 2 diabetes, chronic respiratory disease, chronic kidney disease, stroke, depression, schizophrenia and disability.[5][9][10][11][12][13]
• Promote inclusive participation among people with disabilities and reduce wider inequalities through improved health, autonomy, community inclusion and quality of life.[8][14][13]
• Encourage activity in daily life, active transport, work, leisure and household settings, while reducing prolonged sitting and screen time.[15][16][17]

The guide frames physical activity as an accessible, comparatively low-cost public-health measure, while noting the substantial global and national disease and expenditure burden associated with non-communicable diseases, inactivity and sedentary behaviour.[2][18][7]

Implementation

Implementation is centred on primary healthcare establishments and multidisciplinary teams, with general practitioners serving as an initial point of contact alongside nurses, physiotherapists, pharmacists, midwives and other relevant professionals. Morocco’s Ministry of Health and Social Protection commissioned preparation of the guide, with financial and technical support from the World Health Organization office in Morocco and input from committees, consultants and national non-communicable disease and epidemiology bodies.[19][20][21][1]

• Assess physical activity and sedentary behaviour routinely in consultations, treating activity as a fifth vital sign and recording results to identify patients requiring tailored support.[11][22]
• Use brief assessment instruments, including the Simple Vital Activity Sign, Rapid Assessment Disuse Index and Global Physical Activity Questionnaire, with repeated assessment to follow patient-level change.[11][22][23]
• Screen readiness for increased activity with the Physical Activity Readiness Questionnaire, apply professional judgement, and seek medical or rehabilitation assessment where potential risks are identified.[24][25][26][27]
• Assess readiness for behaviour change through the stages of pre-contemplation, contemplation, preparation, action and maintenance, then tailor counselling and written prescriptions to motivation, health status, preferences and functional ability.[24][25][28]
• Structure prescriptions through frequency, intensity, time and type, encourage gradual progression, and provide practical safety advice on warming up, cooling down, hydration, appropriate equipment and warning symptoms.[28][29][30]
• Apply adult recommendations of 150 to 300 minutes of moderate-intensity aerobic activity weekly, or 75 to 150 minutes of vigorous activity, or an equivalent combination, with muscle-strengthening activity at least twice weekly; encourage people who are inactive to start with smaller amounts.[31][32]
• Adapt activity type, intensity, supervision and setting for clinical conditions, treatment effects, disability, rehabilitation needs and individual contraindications, involving adapted physical-activity teachers, exercise professionals and rehabilitation personnel where appropriate.[11][24][33][34][13]
• Use home, community, rehabilitation, gym, park and everyday-life settings, and encourage walking, cycling, public transport, workplace movement and active domestic or leisure activities.[17][34]

Monitoring is principally clinical and patient-level, based on repeated activity, sedentary-time and readiness assessments, activity trackers where appropriate, and programme parameters such as frequency, intensity, duration, type and supervision.[23][25][34][35]The supplied material does not specify a national implementation timetable, formal governance structure, programme budget, outcome indicator set, reporting system, surveillance framework or accountability mechanism beyond these routine assessment and counselling processes.[21][1][11][36]

Monitoring & Evaluation

Monitoring is principally framed as routine, patient-level assessment in primary care rather than as a national programme-performance system. The supplied material does not set out a unified evaluation framework, reporting cycle, surveillance architecture, formal implementation indicators, targets or accountability arrangements.[19][1][2][36]

• Assess physical activity and sedentary behaviour systematically during primary-care consultations, treating physical activity as a fifth vital sign alongside blood pressure, pulse, temperature and respiration.[11][22]
• Record patients’ usual activity levels and use the result to identify whether tailored advice or intervention is needed.[22]
• Use the adapted physical activity vital sign, also referred to as the Simple Vital Activity Sign, as a two-question assessment that can be completed in about one minute, and repeat it at subsequent consultations to track patient-level change.[11][22][23]
• Use the Rapid Assessment Disuse Index to assess physical inactivity and sedentary behaviour in under five minutes, and use the Global Physical Activity Questionnaire question on sitting or reclining time to assess sedentary behaviour.[11][22][23]
• Measure inactivity through reported time spent moving on one’s feet, climbing stairs and sitting, combined into a cumulative inactivity-risk index.[37]
• Assess readiness for behaviour change through the transtheoretical model stages of pre-contemplation, contemplation, preparation, action and maintenance, including use of a brief exercise-stage questionnaire at the initial consultation.[23][25]
• Screen people planning to begin or increase moderate-intensity activity with the Physical Activity Readiness Questionnaire to identify possible cardiovascular or musculoskeletal risks requiring clinical advice.[24][25][26][27]
• Monitor disease-specific clinical priorities where relevant, including waist circumference as the preferred obesity follow-up parameter rather than weight loss alone.[38]
• Use activity trackers such as pedometers for some stroke-survivor programmes to monitor daily steps and sitting time and support daily activity goals.[34]

The guide uses epidemiological evidence to establish the burden of non-communicable diseases, physical inactivity and sedentary behaviour, including national STEPS survey data on adherence to World Health Organization activity recommendations by sex, age and urban or rural residence.[2][3]Sedentary-behaviour evidence identifies mortality-risk increases above approximately six to eight hours daily of sitting and three to four hours daily of television viewing, with risk patterns also described for all-cause and cardiovascular mortality.[39][40]

Exercise recommendations contain measurable delivery parameters, including frequency, intensity, duration, type, volume and progression. For aerobic activity, the reference volume is 500 to 1,000 metabolic-equivalent minutes per week, approximately 1,000 kilocalories weekly, or equivalent moderate- and vigorous-intensity activity.[41]Muscle-strengthening guidance also specifies repetitions, sets and rest intervals according to intended outcomes and participant profile.[42]These are clinical prescription parameters rather than a specified population-level indicator set.[41][42][43]

Costing & Financing

Financing information is limited. Preparation of the guide received financial support from the World Health Organization office in Morocco, but the material does not provide a programme budget, allocations, expenditure plan, financing mechanism, resource-mobilisation strategy, funding gap or quantified Moroccan implementation costs.[19][20][1]

• Present physical activity and active lifestyles as accessible, low-cost measures with potential to reduce direct and indirect healthcare costs associated with physical inactivity and sedentary behaviour.[2]
• Identify the economic burden of non-communicable diseases in Morocco: 3% of mandatory health-insurance beneficiaries with long-term non-communicable disease conditions accounted for 47.7% of total expenditure in the National Health Insurance Agency report published in 2018.[2]
• Report global 2013 costs of physical inactivity at 67.5 billion US dollars, comprising 53.8 billion US dollars in annual health expenditure and 13.7 billion US dollars in productivity losses.[18]
• Report National Health Service costs in the United Kingdom of 0.8 billion British pounds attributable to prolonged sedentary behaviour in 2016-2017, including costs associated with cardiovascular disease, type 2 diabetes, colorectal cancer, lung cancer and endometrial cancer.[18]
• Report an estimated annual French cost of sedentary behaviour of nearly 17 billion euros, alongside a scenario in which 16.7 billion euros in savings from eliminating sedentary behaviour less 9 billion euros in universal sports-participation costs yields 7.7 billion euros in additional net savings.[18][7]
• Identify financial constraints as a potential barrier to physical activity among stroke survivors, without quantifying the barrier or specifying financial support.[34]
• Present increased health expenditure as a rationale for promoting activity, and describe physical activity as a potentially lower-cost means of achieving health outcomes that may be as effective as prescription medicines for several non-communicable diseases.[36]

The cited economic figures describe the burden or potential savings associated with inactivity and sedentary behaviour; they are not a costed budget for the Moroccan guide or its delivery.[18][7]The supplied text does not provide a costing methodology, unit costs for primary-care assessment tools, workforce costs, financing sources beyond World Health Organization support for preparation, or economic assumptions for implementation.[19][20][11][22]