Directives nationales sur la pratique régulière de l’activité physique pour la santé

Objectives

The 2023 National Guidelines on Regular Physical Activity for Health in Côte d’Ivoire position regular physical activity as a population-health intervention to prevent and manage non-communicable diseases, improve physical and mental wellbeing, strengthen health systems, and support resilient communities.[1][2][3]They align with World Health Assembly Resolution WHA57.17 and the World Health Organization Global Action Plan on Physical Activity 2018–2030.[2][3]

• Promote regular physical activity across the life course to improve muscular, cardiorespiratory, bone, cognitive, functional and mental health, maintain healthy body weight, and reduce risks associated with cardiovascular disease, diabetes, selected cancers, chronic respiratory disease, falls and fractures.[1][4][5]
• Address behavioural risk factors for non-communicable diseases, including physical inactivity, unhealthy diets, tobacco use and harmful alcohol use, through health promotion, prevention, curative action and research.[6]
• Provide standards and practical reference points for safe, regular physical activity, including appropriate facilities and equipment, supervision, medical precautions, activity intensity, clothing, environmental conditions and emergency response.[7][8][9]
• Support age- and condition-specific activity guidance for children and adolescents, adults, older people, pregnant and post-partum women, people living with chronic conditions, and children and adolescents with functional limitations.[10][11][12][13][14]
• Encourage physical activity in domestic life, active travel, work and leisure, including walking, cycling, household work, gardening, sport, exercise and recreation.[5][15]
• Reduce avoidable disease burden associated with inactivity, recognising the global projection of 499.208 million preventable new non-communicable disease cases between 2020 and 2030 if inactivity prevalence remains unchanged.[3]

Implementation

The guidelines use a multisectoral, life-course and safety-oriented delivery model that combines public awareness, trained supervision, accessible activity opportunities, clinical assessment where necessary, adapted programmes for specific populations, and emergency preparedness.[16][7][17]They draw on the World Health Organization framework of active societies, active environments, active people and active systems.[18]

• Coordinate action across health, sport, education, urban planning, transport, construction, culture, security and industry, involving public authorities, employers, community and religious leaders, media, civil-society organisations, sports bodies, researchers and international partners.[16][7]
• Use the National Programme for Combating Metabolic Diseases and Preventing Non-Communicable Diseases as the national structure combining curative, preventive, promotional and research functions.[6]The revision and validation process involved the Ministry of Health, Public Hygiene and Universal Health Coverage, the Ministries of Sports, National Education and Literacy, and Construction, Housing and Urban Development, alongside the World Health Organization and United Nations Development Programme.[16]
• Develop and maintain trained personnel, including health professionals, sports teachers and instructors, adapted physical-activity professionals, social workers, educators, planning professionals, nutritionists, dietitians and psychologists.[19]Provide initial and continuing training in first aid, sport and adapted physical activity, safety, exercise physiology, contraindications, and use of sporting and emergency medical equipment.[20][21]
• Strengthen awareness through administrative and political authorities, religious and customary leaders, employers, social workers and journalists, while maintaining public campaigns for parents, household staff and media personnel.[19][22]
• Support activity in everyday settings where dedicated equipment is not required, while developing specialised centres in major cities, regional public hospitals and regional health centres of excellence.[19]Ensure sites are accessible, safe, hygienic, adequately lit and ventilated, and avoid heavily trafficked locations because of pollution and road-traffic risks.[8][9]
• Apply age-specific recommendations, including at least 60 minutes daily of moderate-to-vigorous activity for children and adolescents aged 5–17 years, aerobic and muscle-strengthening activity for adults, and multi-component balance and strength activity for older people.[11][12]Use weekly timetables as training tools for supervisors and adapt them to participants’ needs and characteristics.[23]
• Provide adapted clinical pathways where health conditions require them: a treating doctor initiates an exercise prescription, an exercise specialist assesses capacity and contraindications, and an adapted physical-activity professional designs and delivers the programme in liaison with clinicians.[17]Determine contraindications through appropriate medical assessment and reassess time-limited restrictions.[24]
• Embed safety measures by encouraging medical consultation before starting activity, especially for people aged 40 years and over, gradual progression, suitable clothing and hydration, avoidance of unsafe climatic conditions, and access to emergency contacts and services.[9][12][25]Emergency preparedness includes first aid, emergency medical assistance, automated external defibrillators where available, and procedures for trauma, bleeding, loss of consciousness, seizures and cardiac arrest.[19][26][27]
• Track progress towards the global target of a 15% relative reduction in insufficient physical activity by 2030; however, the supplied material does not specify a national monitoring framework, reporting cycle, indicator set, surveillance arrangements or formal accountability mechanism.[18][1][10]
• Increase investment in physical activity on the basis of its health and wider social benefits, although no Côte d’Ivoire-specific implementation budget, financing allocation or funding-gap assessment is specified.[16][3]

Monitoring & Evaluation

Monitoring and evaluation arrangements are only partly defined. The guidelines include population-level targets, baseline prevalence figures, periodic capacity-building reviews and clinical reassessment measures, but do not set out a unified national monitoring framework, reporting cycle, surveillance system or formal accountability structure.[18][17][24][20][22]

• Track progress towards the World Health Organization target of a 15% relative reduction in insufficient physical activity by 2030.[18]
• Use the reported baseline context of 31% physical inactivity among adults aged 18 years and over in 2018, including 27% of men and 35% of women; the extract also reports 2017 prevalence of hypertension at 39.9% and diabetes at 6.2%.[18]
• Assess individuals’ physical capacity, exercise-related conditions, indications and contraindications before referral to medically prescribed physical-activity programmes.[17]
• Reassess time-limited contraindications following further clinical examination rather than treating them as automatically permanent.[24]
• Monitor vital measurements regularly for people with type 2 diabetes undertaking tailored activity programmes, and supervise activities for people with stroke.[28]
• Review knowledge of adapted physical activity among relevant supervisors every three years for the 3–5 age group and health personnel, and review primary teachers’ knowledge of physical and sporting activity every three years.[22]
• Strengthen and assess relevant supervisors’ knowledge every two years for programmes serving children aged 6–14 years and people aged 15–65 years.[22][21][29]
• Maintain awareness campaigns as a continuing implementation measure, although no campaign coverage, reach or outcome indicators are specified.[22][21][29]
• Use individual safety monitoring where appropriate, including monitoring exertion and cardiorespiratory parameters such as pulse, blood pressure and oxygen saturation.[9]
• Require people to report chest pain, abnormal breathlessness, palpitations or malaise during or shortly after exertion to a doctor, and encourage periodic medical assessment for intensive sport.[30][31]
• Observe casualties during first-aid incidents, communicate with them where possible and escalate to emergency services or medical advice when serious injury, haemorrhage, abnormal breathing or other deterioration occurs.[26][32][33][34]

Individual assessments, periodic knowledge updates and emergency escalation procedures provide limited operational feedback mechanisms. However, the supplied material does not specify national indicators beyond the physical-inactivity target and prevalence figures, data sources, responsible reporting institutions, publication requirements, audit arrangements, sanctions or other formal accountability measures.[18][20][22][27][35]

Costing & Financing

The guidelines present a strong economic rationale for investment in physical activity and identify human resources, awareness personnel, infrastructure, equipment, specialised services and training as implementation needs. They do not provide a Côte d’Ivoire-specific budget, costed implementation plan, allocation by institution, financing timetable, resource-mobilisation strategy or quantified funding gap.[1][16][19]

• Increase investment in physical activity on the basis of its health benefits, wider positive effects and probable return on investment.[16]
• Recognise technical and financial support from the World Health Organization and the United Nations Development Programme, without specifying the value, duration or allocation of that support.[16]
• Mobilise appropriately trained health professionals, sports teachers and instructors, adapted physical-activity specialists, social workers, teachers, specialist educators, planning professionals, nutritionists, dietitians and psychologists.[19]
• Strengthen or create specialised centres in major cities, regional public hospitals and regional health centres of excellence, while noting that routine physical activity generally does not require dedicated infrastructure or equipment.[19]
• Provide accessible, safe and appropriately equipped activity sites, including sports halls, sports grounds and outdoor health routes; semi-automatic defibrillators are identified as suitable equipment in sports halls where available.[8]
• Support initial and continuing training for supervisors, including first aid, sporting activities, adapted physical activity and, for relevant groups, sports and emergency medical equipment.[20][22]

Global projections cited in the guidelines estimate that unchanged physical-inactivity prevalence could lead to 499.208 million preventable new non-communicable disease cases between 2020 and 2030, with treatment costs of just over 300 billion US dollars, or about 27 billion US dollars annually.[3]The same projection is expressed as 524 billion international dollars in total and 48 billion international dollars annually.[3]Approximately 70% of related health expenditure is expected to be borne by high-income countries.[3]These are global economic projections rather than a national cost estimate for Côte d’Ivoire.[3]

Although physical inactivity is described as imposing a substantial global economic burden, no monetary estimate for Côte d’Ivoire, domestic affordability analysis, economic assumptions for national implementation, or prioritised financing mechanism is specified in the supplied material.[18][3]