Globally, non-communicable diseases (NCDs) are a major health burden and with health behaviours such as tobacco cessation, healthy dietary choices, and low alcohol consumption and or physical activity all proven effective in the prevention and treatment of NCDs; however, limited global responsiveness has been given to the significance of an active lifestyle in disease prevention (Das and Horton, 2016).
Contemporary research findings indicate adolescent and adult physical activity levels have decreased over the past years in both developed and developing countries (McVeigh & Meiring, 2014), leading to concerns relating to several health risks (Monyeki, 2013). Physical activity according to WHO (2015), involves any kind of movement that is instigated by energy- producing muscular function.
Regular engagement in moderate to vigorous intensity physical activity has been shown to guard the individual against chronic diseases and conditions such as obesity, diabetes and coronary heart diseases (Spengler & Woll, 2013). Physical activity has also been shown to provide psychological advantages such as self-confidence and self-image and to prevent breast and colon cancer (WHO, 2015). Likewise, physical activity has proved to be a key determinant of energy expenditure and thus fundamental to energy balance and weight control (WHO, 2010).
According to existing evidence, the world is experiencing a decreasing trend in physical activity levels (Swinburn et al., 2011). Physical inactivity accounted for more than 3 million preventable deaths in 2009 and was recognized as the fourth leading risk factor for non- communicable diseases (Booth et al., 2008). According to world health organization (WHO, 2011), it became the third top risk factor for non- communicable diseases following an increase to 3.2 million. In 2010, physical inactivity and dietary risk factors together accounted for 10.0% of global DALYs (Lim et al., 2012). The prevalence of physical inactivity among adolescents aged 11–17 years was 81% in 2010 according to the global action plan report on physical activity 2017. Adolescent girls were less active than adolescent boys, with 84% vs. 78% not meeting WHO recommendations (WHO, 2019).
Urbanization is emphasized periodically as a factor influencing physical activity, sedentary behaviour and weight status of adolescents. Intuitively, individuals living in urban centers are presumed to be less active with lower levels of physical activity and higher overweight and obesity than those in rural areas, (Springer et al., 2006; Liu et al., 2008; Ismailov and Leatherdale, 2010).
However, studies dealing with the effects of urbanization on physical activity, sedentary behaviour and weight status have not been completely consistent (Cicognani et al., 2008). Potential confounders such as local cultural and social factors, climate and methods of assessment in addition to diverse definition of rural and urban; also makes it difficult to generalize socio-geographic variation in activity and sedentary behaviours associated with weight outcomes across countries. The weight outcomes associated with urban-rural residence may also vary across geographic regions.
There is evidence of an increase in the world’s population living in urban areas (Barreto, 2000). This has been obvious in Ghana with over 50% of the population living in urban centres (GSS, 2014). According to WHO (2015), urban- rural disparity is one of the factors influencing an individual’s behavioural development.
In general, rural communities have limited access to health care, lower preventable morbidity and mortality rates, and low per capita health and professional expertise, especially when compared with urban communities (Muula, 2007).
It has been reported that 80% of 13–15 year olds individuals do not meet the current physical activity recommendation of 60 minutes of moderate to vigorous physical activity per day and thus; the need for more physical activity surveillance data from Africa ( Hallal et al., 2012). According to WHO the problem of NCDs has increased in Africa, and is anticipated to rise further if no action is taken early (WHO, 2011).
The high prevalence of physical inactivity and the influence it has on the current nutritional outcome (BMI) of adolescents is unknown making it difficult to find solutions to the health, economic and psychological consequences it comes with.
There is a gap of data in rural – urban comparative studies that establishes a link between the nutritional status (BMI) of adolescents and the levels of physicals activities they engage in. In Ghana, most studies in this subject turn to dwell more on urban communities to the neglect of rural communities. The reality is that, there could be significant difference in nutritional status and amounts of physical activities undertaken among urban and rural settings. This study therefore, aimed at comparing the level of physical activity and its relationship with nutritional status (BMI) among rural and urban adolescents in the Northern Region.
1.6 Conceptual Framework
The proposed conceptual framework to determine the association between physical activity and nutritional status of adolescents is the ecological model which indicates the different dimensions of associations of physical activity and nutritional status of adolescents (Fig. 1).