1. IMRAN AGUS NURALI
Tackling the Non Communicable
Diseases (NCD) Burden using
Sports and Activities’.

2. OUTLINE PRESENTATION
Introduction
Prevalence NCD’s and Risk factors
Physical Activity and Sports approach
FITT of Physical Activity
Principle of Exercise
Promote Partnership
Conclusion

3. Deaths attributed to 19 leading factors,
by country income level, 2004
WHO Global health Risks report, 2004.

4. Percentage of deaths, by cause, South-East Asia Region, 2008

5. Percentage of deaths, by cause, Indonesia
NBHS 2007
26.9
31.1
Stroke
Hypertension
Diabetes
12.3
9.3
10.2
10.2
Cancer
Heart D's
Others

6. 4 major of NCD’s in Indonesia
NBHS 2007
NBHS 2013
 Cardiovascular disease
- CHD : 0.9%
 Cardiovascular disease
- CHD : 1.5%
- Decomp. Cordis : - Hypertension : 31.7%
- Decomp. Cordis : 0.3%
- Hypertension : 25.8%
 Diabetes Mellitus 1,1%
 COPD : - Asthma : 3.5%
 Tumour/Cancer : 4.3‰
 Diabetes Mellitus 2,1%
 COPD : 3.8% ; Asthma 4.5%
 Cancer : 1.4‰
 Stroke 0,83%
 Central Obesity 18,8%
 Stroke 1,21%
 Central Obesity 26,6%
NBHS : National Basic Health Survey

7. POPULATION AGED +10 YEARS OF PHYSICAL INACTIVITY
by PROVINCE, NBHS 2013

9. Interventions
The NCDs Iceberg
Prevention of
premature deaths and
disability
Management of stroke,
coronary heart disease,
diabetes complications
and COPD
Early diagnosis
Hypertension,
Rx of hypertension,
hyperglycemia,
dyslipidemia, diabetes
HOSPITAL
PRIMARY
HEALTH
FACILITY
Risk factors/diseases
Chronic/life threatening
conditions
-Stroke
-Coronary heart disease
-Diabetic nephropathy
- COPD
Biological risk factors
-Hypertension
-Hyperglycemia
-Dyslipidemia
-Obesity
Behavioral risk factors
Health promotion and
disease prevention
Adoption of healthy
lifestyle by individual,
community and family
-Tobacco
-Physical inactivity
-Lack of fruits
-Lack of vegetables
-Excess alcohol
SOCIAL DETERMINANTS

10. 10

12. LEVEL OF PHYSICAL CONDITION
PEAK
PERFORMANCE
PRODUCTIVITY
FITNESS
HEALTHY
12

13. PHYSICAL ACTIVITY
EXERCISE
SPORT
Good, Right, Measure and Regular

14. CONTINUUM PERIOD OF PHYSICAL ACTIVITY
Pregnancy
and
Postpartum
Children
Adolescents
ATHLETEs
Older
Adults
Adults
PILGRIMS

15. IMPLEMENTATION PROGRAM SPORTS HEALTH
of MoH-Indonesia based on :
1. Guidelines of exercise during pregnancy and
post delivery in Primary Health Centre
2. Guidelines to develop physical fitness of school
age through Health Promotion School (UKS)
3. Guidelines to develop physical fitness for
employee at workplace
4. Guidelines to develop physical fitness for
pilgrims
5. Guidelines to build physical fitness for athletes
6. Guidelines of physical activity for elderly

16. Benefit of Regular physical activity:
TO REDUCE :
•
•
•
•
the risk of dying prematurely
the risk of dying from heart disease or stroke
the risk of developing heart disease, colon cancer and type 2 diabetes
the risk of developing lower back pain can help in the management of painful
conditions, like back pain or knee pain
HELPS TO :
•
•
•
•
prevent/reduce hypertension
control weight and lower the risk of becoming obese
prevent/reduce osteoporosis, reducing the risk of hip fracture in women
build and maintain healthy bones, muscles, and joints and makes people with
chronic, disabling conditions improve their stamina
• prevent or control risky behaviours, especially among children and young
people, like tobacco, alcohol or other substance use, unhealthy diet or violence
• promotes psychological well-being, reduces stress, anxiety and depression

17. Regular Physical Activity at The Correct Intensity





Reduces the risk of death by 40%
Lowers the risk of stroke by 27%
Reduces the incidence of diabetes by almost 40%
Reduces the incidence of high blood pressure by almost 50%
Can reduce mortality and the risk of recurrent breast cancer by
almost 50%
 Can lower the risk of Colon Cancer by 60%
 Can reduce the risk of developing of Alzeimer’s disease by onethird
 Can decrease depression as effectively as medications or
behavioral therapy

18. Mechanism for Cancer Reduction with Exercise
• Physical activity lowers levels of biologically available sex
hormones
– Decreased lifetime exposure to endogenous sex hormones -> decreased risk
of hormone-related cancers
• Breast, endometrial, ovaries, prostate, testes
• Exercise decreases endogenous insulin production
– Higher levels of circulating insulin linked with several cancers
• Adiposity and Cancer Risk
– Increased fat associated with increased risk of cancers of
colon, kidney, esophagus, endometrium, thyroid, post-menopausal breast
• Physical activity decreases colon transit time
– Decreases colonic exposure to carcinogens in stool
• Level of physical activity inversely related to levels of C-reative
protein

19. 3/4/2014
19

20. SITE PLACE OF
PHYSICAL ACTIVITY
1. AT HOME
2. DURING TRAVEL
3. WORKSITE PLACE
4. AT SCHOOL
5. PUBLIC PLACE

21. INTERVENTION :
1.
2.
3.
4.
5.
INDIVIDUALLY BEHAVIOUR PROGRAM
SCHOOL BASED PHYSICAL EDUCATION
ENVIRONMENTAL APPROACHES
COMMUNITY CAMPAIGNS
SOCIAL SUPPORT INTERVENTIONS IN
COMMUNITY
6. POLICY APPROACHES

22. PRESCRIPTION OF EXERCISE :
1.
2.
3.
4.
FREQUENCY
INTENSITY
TEMPO
TYPE

23. PRINCIPLES OF EXERCISE
1. OVERLOAD
2. PROGRESSIF
3. INDIVIDUAL

26. Promote Partnerships for The
Prevention and Control of NCD’s
1. Promote agreement between the government and other
relevant partners in the implementation of national strategy
of diet and physical activity for NCD’s prevention
2. Reorient the role and existence of a national network of
NCD’s control
3. Strengthen the role of existing networking in province and
district of NCD’s control
4. Develop national action plan for implementation of diet
and physical actiivty for NCD’s prevention

27. NATIONAL
POLICY
•
• Food availability
and access
•
• Improved
quality of food
consumption
•
• Improve d
physical activity
•
• Public Health
and Community
Nutrition
•
•
•
•
•
•
•
•
PROGRAM
IMPLEMENTATION
Strengthen regulation of low
salt, low sugar and low
saturated fat of food products
Strengthen the role of
networking in province and
district on NCDs control
Increase budget allocation and
the means to support the
activities
Integrate activities to control
risk factors of NCDs related to
diet and physical activity into
Social Security System
Adopt community-based
interventions adaptive to local
social and culture wisdom
Conduct research on the impact
of behavior changes in
consumption of sugar, salt, fat
and physical activity on NCDs
prevalence reduction
INPUT & PROCESS
INDICATOR
• Regulation of low salt, low
sugar and low saturated
fat of food products
• Effective NCDs control
networking
• Budget allocation for
program implementation
• NCDs control of
vulnerable group incl. the
poor
• Community-based
interventions adaptive to
local social and culture
wisdom
• Research on the impact of
behavior changes in
consumption of sugar, salt,
fat and physical activity on
NCDs prevalence
reduction
OUTPUT
INDICATOR
Increased
percentage of
family with
healthy life style
behavior of low
sugar, salt, fat
consumption and
regular and
adequate physical
activity
NATIONAL STRATEGY
Strengthen legislation on healthy diet and physical activity.
Multi-sector and stakeholders partnerships include strengthen National Networking of NCDs Control.
Resource development for the implementation of activities /actions.
Address equity and equality and eliminating disparities among social groups.
Increase the effective evidence-based interventions by place settings (households, schools, public places,
workplaces and health care facilities)
Conduct operational research and development of policy and long-term strategy for sustainable NCDs
community-based prevention.
REDUCTION OF
NCDs
PREVALENCE

28. Linkage between Components of Diet and Physical Activity
ECONOMY AND
GLOBALIZATION
MEDIA
ADVERTICEMENT
AND SOCIAL
NETWORK
DIET AND
PHYSICAL
ACTIVITY
LEGISLATION,
BUDGET AND
CONTROL
ENVIRONMENT
AND INFRA
STRUCTURE
FOOD AND
NUTRITION
SOCIOCULTURE,
TOURISM AND
LOKAL WISDOM
KNOWLEDGE,
GENDER &
LIFESTYLE

29. Stakeholders of National Network
of NCD’s Control
1. Bappenas (National Development
Planning Agency)
2. Home Affairs
3. The House of People
Representatives
4. Province and District Government
5. Health
6. Agency For Drugs and Food
7. Education
8. Religious Affairs
9. Youth and Sports
10.Agriculture
11.Marine and Fisheries
12.Labor
13.Trade
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Industry
Tourism
Fiscal
Industrialist and Businessman
Woman empowerment and Child
Protection
Social and Human Rights
Non Government Organization
Mass Media
Professional Organizations
Universities
UN Agencies and International
Develeopment Partners

30. PHYSICAL ACTIVITY OF SCHOOL AGE
8/29/2013

31. IAN 2012

32. PHYSICAL FITNESS TEST AT WORKPLACE

33. EXERCISE FOR PILGRIMS

36. CITY PARK

37. CONCLUSION
Physical inactivity is part of the problem
Physical activity is part of the solution
Intervention
to increasing physical activity

39. THANK YOU