I C A L A C T I V I T Y C O U N T R Y P R O F I L E Italy physical activity country profile: results from the first set of country cards of the Global Observatory for Physical Activity - GoPA!

The Global Observatory for Physical Activity – GoPA! country cards were launched last Dec 4th in London [1]. GoPA! was created in response to the urgent call to action to prevent the physical inactivity pandemic described in the Lancet physical activity series back in 2012 [2,3]. These population, researcher and policy maker friendly profiles aim to contribute promoting physical activity worldwide. Each profile put together a set of prevalence, health burden, research, surveillance and policy indicators. Each country has a representative that reviews the content presented in the card. Italy was launched in the first set of cards and it has an interesting profile. Main questions that were answered:

The Global Observatory for Physical Activity -GoPA!country cards were launched last Dec 4th in London [1].GoPA! was created in response to the urgent call to action to prevent the physical inactivity pandemic described in the Lancet physical activity series back in 2012 [2,3].These population, researcher and policy maker friendly profiles aim to contribute promoting physical activity worldwide.Each profile put together a set of prevalence, health burden, research, surveillance and policy indicators.Each country has a representative that reviews the content presented in the card.Italy was launched in the first set of cards and it has an interesting profile.Main questions that were answered:

Which is the prevalence of physical inactivity in Italy?
In the Lancet Physical Activity Series launched in 2012, using data from 122 countries, it was estimated that 31.1% [2] of the world's adult population was physically inactive (recommendation of 150 minutes per week of moderate-tovigorous intensity physical activity per week) [4].
Italy has 33% of physical inactivity, with women being more inactive compared to men.This data is quite similar to the study of population PASSI 2013 (33% of women is sedentary versus 29% of men), but it is important to consider that the age range considered in the two studies are very different: PASSI considers women aged >17; GoPA! women and girls aged > 8 years [5].

Which is the health burden of physical inactivity in Italy?
Among the health effects of physical inactivity there are increased risk of high blood pressure, stroke, metabolic syndrome, depression and falls.In 2013, it was estimated that physical inactivity was responsaible for 6% of coronary heart disease deaths, 7% of type 2 diabetes deaths, and 10% of all breast and colon cancer deaths [6].
Compared to the world estimate of 9% of the deaths related to physical inactivity, Italy has a greater percentage of deaths due to physical inactivity (14.6%).
e 1 1 6 4 9 -1 How is Italy doing in terms of surveillance?
In Italy there are two main surveillance systems that produce data on physical activity level: "PASSI" and "Okkio alla salute".PASSI survey shows that 30% of people of 18 to 69 year old do not meet physical activity recommendations, defined as at least 30 minutes of physical activity every day, therefore we can consider them physically inactive.Factors associated to physical inactivity in adolescents and adults are low educational level and living in a low income region [7][8].According to the children survey "Okkio alla salute" only one out ten children has appropriate physical activity levels [9].Sixteen percent of the children reported not making any physical activity the day before the interview.Other data are available from ISTAT, the Italian National Institute of Statistics, but it is important to underline that comparability between different surveillance systems is not always possible.

How is Italy doing in terms of research?
Italy is among the first 10 in research worldwide in 2013 according to a PubMed search conducted by GoPA!.This is not surprising.Research in the field in Italy is not new, with decades of records in PubMed.Recent publications in the last years show the availability of the Italian version of the International Physical Activity Questionnaire (IPAQ), both long and short form [10] and since 2010 also the telephone Italian version is available [11].

How is Italy going in terms of physical activity policy?
Having a standalone physical activity plan represents still a gap for Italy.There is not a system that promotes and monitors physical activity at national level, representing an opportunity for improvement at the country level.In Italy while the central government provides a stewardship role, setting the fundamental principles and goals of the health system and determining the core benefit package of health services available to all citizens, the 21 Regions are responsible for organizing and delivering primary, secondary and tertiary health-care services as well as preventive and health promotion services [12].In this context it is easy to imagine that different management, results, health expenditure and different planning for health promotion do exist.Some Italian Regions have realized local interventions or quasiexperimental surveys in order to promote physical activity, but only one national project was developed in 2007 "Guadagnare salute" [13], altought there are no new results available.Therefore, there is a strong need to suggest and plan new strategies at national level to promote physical activity in different settings.The GoPa! Italian Cards summarized this situation and now represent and advocacy tool to be used at a country level to highlight these gaps (Figure1).

Which are the future steps to tackle physical inactivity in Italy?
We are certain that engaging with GoPA! represents an opportunity to improve our standardized data collection, surveillance systems, policy making, research, health burden statistics, program development and evaluation related to physical activity.Also that the Italian country card will become advocacy tool to improve our populations physical activity level.Moreover, this initiative has represented for the Italian GoPA! working group an incentive to start systematically evaluation of interventions on the Italian territory at regional and local health units levels.Knowing the initiatives for the promotion of physical activity is the basis for having a picture of the situation: what are the interventions, their recipients, their feasibility and their effectiveness are necessary information to be subsequently reviewed as policies to be implemented at the national level.