The aim of this study was to investigate the and to examine the exercise barriers which are prevailing in today’s generation. A total of 212 physiotherapy students aged between 18 and 25 years participated in the study, out of which 127 were girls and 85 were boys. The students were categorised based on the metabolic equivalent (MET) values in the International Physical activity Questionnaire and an External Barrier Items as high, moderate and low levels of physical activity. Total sitting time and reasons for external barriers were also calculated. The results were analysed using measures of central tendency and percentage. The study revealed that most of the students fall under low and moderate levels of physical activity. External barriers were more influencing than the internal barriers. Busy lesson schedule, no fitness centre, no encouragement from family and friends were the most commonly said by the students for not exercising. The mean average sitting hours in males were 5 hours and 8 minutes per day and for females its 6 hours and 31 minutes.
Conclusion:-
From this study it is concluded that Physical Activity trends were categorised under low and moderate for Physiotherapy students in Coimbatore.
Key words: Physical Activity, Exercise Barriers, International Physical Activity Questionnaire, Metabolic Equivalent.
1. INTRODUCTION
Physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure.
The term “physical activity” cannot be interchanged with “exercise”. Exercise, is a subgroup of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. Physical activity comprises of exercise as well as other activities which involve bodily movement and are done as a part of playing, working, active transportation, house chores and recreational activities.
Regular and adequate levels of physical activity in adults reduces the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer, depression and the risk of falls. It also improves bone and functional health. Physical activity is a prime determinant of energy expenditure, and thus fundamental to energy balance and weight control.
Metabolic Equivalents (METs) expresses the intensity of physical activities. MET is the ratio of an individuals working metabolic rate relative to their resting metabolic rate.
One MET is defined as the energy cost of sitting quietly and is equivalent to a caloric consumption of 1kcal/kg/hour.
World Health Organisation estimated that compared with sitting quietly, a person’s caloric consumption is three to six times higher when being moderately active (3-6 METs) and more than six times higher when being vigorously active (>6 METs).
Intensity of physical activity refers to the rate at which the activity is being performed or the magnitude of the effort required to perform an activity or exercise. It can be thought of “How hard a person works to do the activity”.
The intensity of physical activity varies between people. The intensity of physical activity depends on an individual’s previous exercise experience and their relative level of fitness. The examples below are provided as a guide only and will vary between individuals.
The types of intensity of physical activity are classified into 3 namely vigorous intensity, Moderate intensity and Low intensity physical activity.
Physical inactivity (lack of physical activity) is the fourth leading risk factor for global mortality (6% of deaths globally).
For non communicable diseases physical inactivity is a one among the important independent risk factors which caused more than 35 million deaths in 2005. 80% of deaths due to non communicable diseases prevail among low and middle income countries. Therefore physical inactivity associated with non communicable diseases is a significant public health problem in most countries around the world.
1.1. NEED FOR THE STUDY:
In all developing countries, the levels of inactivity are becoming virtually high. Physical inactivity has become a great problem even in rapidly growing large cities of the world. Urbanization has influenced physical activity to a great extent that it affects even transport and occupation domains.
Even in rural areas of developing countries, sedentary life styles like watching television and using motor vehicles have increased far more than normal. The adolescent period represents a transition from childhood to adulthood and lifetime habits such as regular exercise are normally begun at this time (Anderson and Haraldsdottir, 1993; Engstrom). So there is a need to study the prevalence of physical activity among students.
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In this study physiotherapy students are recruited because they very well know the importance of physical activity and hazards of physical inactivity. Even though knowing the importance of physical activity, are they really active is the question to be asked. There are certain barriers which hinder the students from exercising which in turn has an effect on the physical activity of the students. These barriers can be either internal or external. Through this study the prevalence of physical activity and the causes for the exercise barriers are to be evaluated.
Increasing physical inactivity is not only an individual threat but also a social problem. Therefore it demands a multi disciplinary, multi sectoral population based and culturally relevant solution in accordance to recent trends.
2. REVIEW OF LITERATURE
2.1. PHYSICAL ACTIVITY:
Carl A et al defined physical activity as any bodily movement produced by skeletal muscles that require energy expenditure.
Caspersel defined physical activity as the behaviour that result in any movement contributing to human total energy expenditure.3
2.2. PREVALENCE OF PHYSICAL ACTIVITY:
Xiaofen Deng Keating et al have concluded that about 50% of students were physically inactive based on review study in physical activity behaviours. The study also insisted that health and physical activity professionals in higher education have not been able to effectively influence any increase in student’s physical activity.33
After analyzing the participation of specific population in physical activity and exercises Nicolas et al recommended specific policies, strategies and campaigns to the general public to increase participation in physical activities. It was suggested that future researchers should focus more on longitudinal and intervention studies.
Cust et al have reviewed the epidemiological evidence linking physical activity with endometrial cancer risk in three separate reports published in 2007 which all reached the same conclusion, that physical activity probably reduces endometrial cancer risk, with active women at a 20-40% reduced risk of endometrial cancer relative to inactive women.5
2.2.1. LEISURE TIME ACTIVITY
Martinez Gonzalez et al estimated the prevalence of physical activity during leisure time in adults using metabolic equivalents (METs) and characterised physical activity intensity as low, moderate and vigorous.18
Jane et al determined the influence of leisure-time physical activity and weekly alcohol intake on the risk of fatal ischaemic heart disease and causes of mortality. They conducted a cohort study with 20 years of follow up study. It was concluded that leisure time activity and moderate weekly alcohol consumption are important to lower risks of ischemic heart disease.13
2.2.2. WORK TIME ACTIVITY
Timothy et al examined the intensity of ambulatory physical activity patterns in college students and showed that subjects were more active on weekdays during work than the weekend.30
2.2.3. GENDER IN PHYSICAL ACTIVITY:
Adrian Bauman et al noted gender difference in intensity of physical activity especially among young adults, and it was found that males were more active than females in most countries. The subjects have reported less vigorous intensity activities and mostly walking.1
Santos P et al documented the age and gender-related physical activity levels in school children using Computer Science and Application activity monitor to measure the daily physical activity. It was found that boys involved in increased number of continuous physical activity than girls. The study concluded with suggestions of future studies to compare the different variables to compare physical activity.23
Timothy et al determined that daily, weekday, and weekend intensity of ambulatory physical activity did not differ between genders.30
2.3. BENEFITS OF PHYSICAL ACTIVITY:
Morris JN conducted a forty years of population studies to show that physical activity can protect against coronary heart disease (CHD) in men. The study concluded that the initiation of the physical activity is the need of the hour.
Seppo Miilunpalo revealed that physical activity helps to improve health-related quality of life by enhancing psychological well being. It also revealed improvement in physical functioning in persons with poor health.25
The health effects of a daily physical activity programme studied by Dwyer et al in 10-year-old school children suggested that daily physical activity programmes enhances beneficial effects to prevent obesity in school children. Also the study concluded that there was no significant academic loss. The arithmetic mean was used to measure the study results.7
The effects of intense physical activity on students during different hours of daily class were evaluated by Travlos et al. The study concluded that aerobic run during classes enhanced physical activity and that physical activity improved cognitive performance in students.31
Mary K. examined the understanding of physical activity in college students. A questionnaire was provided to collect data on physical activity. They concluded that the students were confused with the definition and the frequency of physical activity needed. Thus it is necessary to increase awareness about physical activity and its benefits in students.19
James Wood Cock et al have conducted a systematic review and meta-analysis to quantify the dose-response relationship of non-vigorous physical activity and causes of mortality. All cohort studies with a sample size of more than 10,000 participants were included in the study to estimate the effect of various levels of light or moderate physical activity which leads to mortality. They have concluded that being physically active reduced all possible risks of mortality.11
McTiernan hypothesized that physical activity decreases endometrial cancer risk because it reduces serum levels of estradiol and increases levels of sex hormone binding globulin (SHBG) and the binding protein for estradiol. These effects of physical activity have been mediated through prevention of weight gain. In postmenopausal women, adipose tissue and the aromatization of androgen precursors, which occurs within this tissue, is the primary source of estrogen (Siiteri, 1987). Consequently, women who maintain a healthy body weight tend to have lower circulating estrogen levels (Calle and Kaake, 2004).
2.4. BARRIERS OF PHYSICAL ACTIVITY:
Arzu Daskapan et al have identified certain benefits and barriers to physical activities of college students and concluded that national standardized instrument for analysing physical activity was helpful to identify the perceived barriers and recommended changes to enhance physical activity among young people.2
Fiona C. Bull et al have analyzed the past and current international developments on physical activity and its barriers. The analysis concluded that increase in physical inactivity due to lack of appropriate action may become a major cause for non communicable diseases.8
2.5. PHYSICAL INACTIVITY:
Ilkka Vuori stated that physical activity provides an essential stimuli for most organs of the human body, to develop and maintain their structures and functions meeting the general requirements of life. Chronic physical inactivity leads to dysfunction of health, while physical activity helps to increase or improve organ function. Most of these effects were related to disorders or their precursors or risk factors.10
Linda J. Cobiac et al stated physical inactivity as a key risk factor for many chronic diseases and large number of population do not understand the necessicity of physical activity. This study mainly concerns with the cost effectiveness of the interventions and questionnaires used to promote physical activity.17
Senbanjo et al revealed that physical inactivity and sedentary lifestyles were known to be predisposing factors of overweight and obesity. Physical activity was more in older children, males and children of mothers with high educational level. 1.9% children were obese whereas 163 (28.6%) were underweight. The prevalence of obesity was low but under nutrition is a major nutritional problem among these children.24
Emine Handan Tuzun has indentified accurate perceived barriers and recommended some changes to enhance physical activity among young adults.2
2.6. INTERNATIONAL PHYSICAL ACTIVITY QUESTIONNAIRE
Craig CL et al have used the International Physical Activity Questionnaire (IPAQ) as an instrument for cross-national monitoring of physical activity and inactivity in a study. It was used to calculate the physical activity of the usual week. It can be used in a wide range of population, from 18 to 65 years in diverse settings.4
Sidsel Graff-Iversen et al reported seasonal variations in physical activity using the long international physical activity questionnaire (IPAQ-L). The results obtained were calculated with anthropometrical measurements. The physical activity was correlated with waist to hip ratio. The study concluded with consistent correlations among the baseline biological and anthropometrical measurements in both sexes.26
Adrian Bauman showed that IPAQ is an acceptable surveillance instrument which can be used for physical activity.1
By self-report questionnaires Kalaja et al assessed physical activity along with other domains like engagement and enjoyment. The analysis revealed that only perceived physical activity competence was more statistically significant predictor of physical activity than other domains.15
2.7. EXERCISE BARRIERS ITEMS
Bauldoff GS & Casaburi R have recognised the major barriers to increasing physical activity, which was addressed with individuals and effective strategies were worked out for advance.14
Ziebland S has assessed anticipated barriers which changes diet and exercise and also related subsequent behaviour changes.34
2.8. METABOLIC EQUIVALENT [MET]
Min Lee evaluated moderate-intensity physical activity, requiring about 3 METs (metabolic equivalents) for 30 minutes in daily activities. The baseline activities were measured using Borg scale. About 551 developed CHD. Thus it is important to recommend appropriate levels of physical activity rather than blindly co relating with METS.20
Elizabeth Dean has described the energy costs in METs of physical activity exercise as very light, light, moderate to heavy and very heavy activity.6
Julie Ann Starr has reported graded exercise test and functional capacity in terms of Vo2, or maximum METs, attained during exercise.29
2.9. SUMMARY
Most of the studies related to prevalence of physical activity were conducted in the western population. In India, the incidence of Ischemic Heart Disease is rapidly increasing, so as a measure to screen and manage these aspects, this study was designed to evaluate the prevalence and barriers of physical activity among Physiotherapy students in Coimbatore.
3. AIM AND OBJECTIVES
3.1. AIM OF THE STUDY
To study the prevalence and barriers of physical activity among Physiotherapy students in Coimbatore.
3.2. OBJECTIVES
Find how physically active Physiotherapy students are and
Also to evaluate the internal and external barriers for physical activity.
4. MATERIALS AND METHODOLOGY
4.1 STUDY DESIGN
Descriptive study design
4.2 STUDY SETTING
1. KOVAI MEDICAL CENTER AND HOSPITAL,
COLLEGE OF PHYSIOTHERAPY,
COIMBATORE.
2. KG COLLEGE OF PHYSIOTHERAPY,
COIMBATORE.
3. SRI RAMAKRISHNA INSTITUTE OF PARAMEDICAL SCIENCES,
COLLEGE OF PHYSIOTHERAPY,
COIMBATORE.
4. RVS COLLEGE OF PHYSIOTHERAPY,
COIMBATORE.
5. PPG COLLEGE OF PHYSIOTHERAPY,
COIMBATORE.
6. PSG COLLEGE OF PHYSIOTHERAPY,
COIMBATORE.
7. CHERRAN’S COLLEGE OF PHYSIOTHERAPY,
COIMBATORE.
4.3. STUDY POPULATION
Total of 225 physiotherapy students
4.4. SAMPLING TECHNIQUE
Purposive sampling technique
4.5 CRITERIA FOR SELECTION:
4.5.1. INCLUSION CRITERIA:
18 to 25 years.
Both genders.
4.5.2. EXCLUSION CRITERIA:
Systemic illness.
No recent fractures.
People in regular athletics.
4.6. T
OOLS OF DATA COLLECTION:
International Physical Activity Questionnaire [Long form]
Exercise barrier items
4.7. PROCEDURE:
Physiotherapy students who met the inclusion criteria are selected for the study and informed consent is obtained from them prior to the study. The students are asked to answer the various domains of the International physical activity questionnaire and the Exercise barrier items.
The International Physical Activity Questionnaire comprises of both long and short forms. In this study long form of the questionnaire is used. The long form questionnaire consists of 5 activity domains namely work, transport, domestic and yard, leisure and sitting. The first 4 activity domains are scored based on Metabolic Equivalent [MET] levels. The sitting activity domain is calculated in minutes. The domain sub scores are calculated as follows:
Domain Sub Scores
Total MET-minutes/week at work = Walk (METs*min*days) + Mod(METs*min*days) + Vig(METs*min*days) at work
Total MET-minutes/week for transportation = Walk (METs*min*days) + Cycle(METs*min*days) for transportation
Total MET-minutes/week from domestic and garden = Vig (METs*min*days) yard work +Mod (METs*min*days) yard work + Mod (METs*min*days) inside chores
Total MET-minutes/week in leisure-time = Walk (METs*min*days) + Mod (METs*min*days)+ Vig (METs*min*days) in leisure-time
Total Physical Activity Score
Total Physical Activity MET-minutes/week = Walking MET-minutes/week + Moderate METminutes/week + Total Vigorous MET-minutes/week
The sitting time is calculated as follows:
Sitting Total Minutes/week = weekday sitting minutes* 5 weekdays + weekend day sitting minutes* 2weekend days
Average Sitting Total Minutes/day = (weekday sitting minutes* 5 weekdays + weekend day sitting minutes* 2 weekend days) / 7
The Exercise barrier items are used to evaluate the barrier for exercise. The Exercise barrier items are divided into internal and external barriers. Each barrier consists of 6 items. The students are asked to select the most appropriate reason for not engaging in regular exercises.
4.8. STATISTICAL TOOL:
Data collected are analyzed using measures of central tendency -Mean and Percentage.
5. DATA PRESENTATION
5.1. TABULAR PRESENTATION
Table I:- Female Work Domain
WORK
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
66
59
2
Average Mean
[METs]
181.0152
1221
3894
Table II:- Female Transport Domain
TRANSPORT
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
102
25
0
Average Mean
[METs]
243.3137
1055.36
0
Table III:- Female Leisure Domain
LEISURE
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
101
25
1
Average Mean
[METs]
149.495
1090.28
3686
Table IV:- Female Yard Domain
YARD
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
92
32
3
Average Mean
[METs]
222
1017.06
3690
Table V:- Female Total Physical Activity
TOTAL
PHYSICAL
ACTIVITY
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
21
79
27
Average Mean
[METs]
346.14
1651.089
4147.778
Table VI:- Sitting [Females]
SITTING
MINUTES
HOURS
Mean Average
per Week
2650.39
44.17
Mean Average
per day
378.77
6.31
Table VII:- Male Work Domain
WORK
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
61
24
0
Average Mean
[METs]
201.5738
980.75
0
Table VIII:- Male Transport Domain
TRANSPORT
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
61
24
0
Average Mean
[METs]
258.6557
965.5417
0
Table IX:- Male Leisure Domain
LEISURE
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
54
28
3
Average Mean
[METs]
145.6667
1299.786
3988
Table X:- Male Yard Domain
YARD
DOMAIN
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
61
24
0
Average Mean
[METs]
201.5738
980.75
0
Table XI:- Male Total Physical Activity
TOTAL
PHYSICAL
ACTIVITY
LEVEL OF PHYSICAL ACTIVITY
LOW
MODERATE
HIGH
Number of
Students
8
51
26
Average Mean
[METs]
281.75
1708.039
4549.231
Table XII:- Sitting [Males]
SITTING
MINUTES
HOURS
Mean Average
per Week
2484.41
41.40
Mean Average
per Day
349.04
5.81
5.2. GRAPHICAL PRESENTATION
FEMALES: Total =127 female students
Work domain in females
CHART I
GRAGH I-Mean values [METs]
Transport domain in females
CHART II
GRAPH II-Mean values [METs]
Yard domain in females
CHART III
GRAPH III-Mean values [METs]
Leisure domain in females:
CHART IV
GRAPH IV-Mean values [METs]
Total Physical activity in females
CHART V
GRAPH V-Mean values [METs]
MALES :
Total = 85 male students
Work domain in males
CHART VI
GRAPH VI-Mean values [METs]
Transport domain in males
CHART VII
GRAPH VII-Mean values [METs]
Yard domain in males
CHART VIII
GRAPH VIII-Mean values [METs]
Leisure domain in males
CHART IX
GRAPH IX-Mean values [METs]
Total Physical Activity in males
CHART X
GRAPH X-Mean values [METs]
EXERCISE BARRIER ITEMS
Internal barriers
CHART XI
External barriers
CHART XII
6. DATA ANALYSIS & INTERPRETATION
The interpretation of the physical activities was analysed using mean values and the number of students falling into each category. Totally there were 212 students, out of that 127 were females and 85 were males. They were categorised under separate modules as high, moderate and low according to the met levels instructed in the IPAQ.
6.1. FEMALES
WORK DOMAIN IN FEMALES
Out of 127 students 66 were in low, 59 in moderate and 2 in high. Their mean values were 181.01, 1221 and 3894 METs respectively.
TRANSPORT DOMAIN IN FEMALES
In this domain 102 were in low, 25 in moderate and none of them in high. Their mean values were 243.31, 1055.36 and 0 METs respectively.
YARD DOMAIN IN FEMALES
In this domain 92 were in low, 32 in moderate and 3 in high. Their mean values are 222, 1017.06 and 3690 METs respectively.
LEISURE DOMAIN IN FEMALES
In this domain 101 were in low, 25 in moderate and 1 in high. Their mean values were 149.45, 1090.28 and 3683 METs respectively.
TOTAL PHYSICAL ACTIVITY IN FEMALES
In this domain 21 were in low, 79 in moderate and 27 in high. Their mean values were 346.14, 1651.08 and 4147.77 METs respectively.
SITTING
Total mean sitting is 2650.394 minutes which is approximately 44 hours and 17 minutes per week.
Average mean sitting is 378.77 minutes which is approximately 6 hours and 31 minutes per day.
6.2. MALES
WORK DOMAIN IN MALES
Out of 85 students 40 were in low, 42 in moderate and 3 in high. Their mean values were 173.65, 1236.40 and 3797.66 METs respectively.
TRANSPORT DOMAIN IN MALES
In this domain 61 were in low, 24 in moderate and none of them in high. Their mean values were 258.65, 965.54 and 0 METs respectively.
YARD DOMAIN IN MALES
In this domain 61 were in low, 24 in moderate and 0 in high. Their mean values are 201.57, 980.75 and 0 METs respectively.
LEISURE DOMAIN IN MALES
In this domain 54 were in low, 28 in moderate and 3 in high. Their mean values were 145.66, 1299.78 and 3988 METs respectively.
TOTAL PHYSICAL ACTIVITY IN MALES
In this domain 8 were in low, 51 in moderate and 26 in high. Their mean values were 281.75, 1708.03 and 4549.23 METs respectively.
SITTING
Total mean sitting is 2484.41 minutes which is approximately 41 hours and 40 minutes per week.
Average mean sitting is 349.04 minutes which is approximately 5 hours and 8 minutes per day.
6.3. EXERCISE BARRIER ITEMS
Total 212 students.
6.3.1. Internal barriers
Total number of students = 14 students which is 6.6%
Exercise is difficult and tiring = 14.28%
Lack of energy to do exercise = 14.28%
Never thought that exercise would have positive effects = 50%
Worried about my looks while exercising = 14.28%
No ability to exercise = 7.14%
6.3.2. External barriers
Total number of students = 198 students which is 93.39%
No time due to busy lesion schedule = 49.49%
No fitness centre nearby = 21.21%
No encouragement from friends and family = 11.61%
Parents give only academic priority over exercise = 10.10%
Social and family responsibilities = 5.05%
No equipments at home = 2.52%
7. DISCUSSION
The importance of physical activity and exercise is a known fact. But the question is ‘do people really take it up seriously’. Until they come across some non communicable diseases people do not even think about exercises or physical activity. So this is a descriptive study in which the prime objective was to analyze the prevalence of physical activity and secondly to know the various reasons which stand up as barriers to physical activity.
Lifestyle has changed so much that even students come under the influence of physical inactivity. In this study, physiotherapy students were recruited because the importance of physical activity and exercise were well known to them.
In this study International Physical Activity Questionnaire and Exercise barrier items were given to students of various physiotherapy colleges in Coimbatore and data were collected. Totally 225 were Questionnaire obtained and 13 questionnaires were excluded since they were incomplete. So 212 questionnaires were considered of which 127 were females and 85 were males.
On seeing the results in the work domain both males and females, many were categorised as low and moderate. This was because there were no possibilities of even minimal physical activity during class hours. And the sitting hours was also 5 to 6 hours per day without including sleeping hours. But physical activity was not even more than 2 hours per day. Sitting hours were also high due to increased hours of watching television, browsing the net, using library, chatting in phone and with friends, going to movies and day dreaming in fantasies.
In the transport domain students were more in low and moderate levels. This was because of lifestyle changes that even to nearby place students prefer to go by bike or car. Possibilities for bicycling were very low in today’s trend and this scenario could become much worse in the coming years.
In the domestic and garden domain the students were more in the low and moderate category. This was because most of the students in Coimbatore stay in hostel so there is no possibility other than that of studying or chatting with friends. No suitable environment is also a key factor .
In leisure domain also more students were in moderate and low. The reasons for not doing exercise in leisure time were busy lesson schedule ,no encouragement from parents and friends ,no fitness centre nearby and academic priority over exercises.
The results may vary if the study would have been conducted in metropolitan cities because their socio cultural and economical background differs to a great extent.
Since the physiotherapy students knew the importance of physical activity the exercise barriers were more externally influenced.
Once the internal barriers are add
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