Comparing the level of physical activity among Obese and Normal BMI females in Chennai using International Physical Activity Questionnaire (IPAQ) – A Case Control Study
Kiruthika S¹,
Sathya P²
¹Final year Postgraduate,
²Director & Professor, Institute of Physiology and Experimental Medicine, Madras Medical College, Chennai, Tamil Nadu.
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Abstract:
Background: Recently, it has been shown that sedentary behavior poses a significant risk for cardiometabolic disorders. Numerous studies have demonstrated the link between sedentarism and higher body weight, and consistent exercise can not only improve muscular strength, and aerobic capacity, muscle mass, flexibility, decrease in body fat, and but also reductions in blood pressure, anxiety, and stress levels. The purpose of the study was to understand the level of physical activity engaged by obese and normal BMI females on a daily basis since women have better tendency to get fat deposition than males and also women have lack of knowledge regarding physical activity. Aim: The aim of this study is to assess the physical activity among obese and normal BMI females by using International Physical Activity Questionnaire (IPAQ). Materials and methods: The study was started after obtaining approval from Institutional Scientific and Ethics committee. The study was conducted in OPD at Madras Medical College. Females between 18-50 years were included in the study. The sample included 25 obese females with BMI >30 as cases and 25 non-obese females with BMI between 18.5 to 24.9 as controls based on the BMI classification of WHO. Both the groups were given Long last 7 days self-administered IPAQ which contains a total of 27 questions enquiring about time spent in physical activity in the last 7 days. Results: To compare the mean of two groups unpaired t-test was used. The mean age, height, weight, and BMI of two groups were compared and the mean age, weight and BMI were significantly higher among cases and the mean height was significantly higher among the controls. The association between physical activity and obesity in this study was found by using Fisher exact chi square test. It showed a significant p value of 0.0001, as the number of females involved in health enhancing physical activity i.e., at least 1.5- 2 hours of being active throughout the day, was less among obese females. Conclusion: This study seeks to highlight the lack of physical activity among the majority of the female population in the reproductive age range by classifying the amount of physical activity these women engage in a regular basis.
Keywords: BMI, females, physical activity
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Corresponding Author:
Dr. P. Sathya, Director & Professor, Institute of Physiology and Experimental Medicine, Madras Medical College, Chennai, Tamil Nadu Contact No: 9841814090, E-mail : [email protected]
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Introduction:
Physical activity is a part of healthy life style. It increases energy expenditure and helps in regulating body weight.1 It improves physical and mental health. Engaging in physical activity may increase the brain’s synthesis of endorphins, which are neurotransmitters that gives a sense of well-being. The definition of “physical activity,” which is the most inclusive of the three terms, is “any bodily movement produced by skeletal muscles that results in energy expenditure.7
An inadequate level of moderate to vigorous physical activity (MVPA), or failing to meet specified physical activity guidelines, was referred to as physical inactivity. Any behavior that involves little energy expenditure or energy expenditure of less than 1.5 metabolic equivalents (METs) while sitting or lying down is referred to as sedentary behavior.12 Irrespective of the nation’s income level, obesity is a chronic illness that affects people of all ages and socioeconomic backgrounds.
Of non-pregnant women aged 20 to 39, 29% are obese and 26% are overweight. Women’s health is adversely affected by obesity in numerous ways. Women who are overweight or obese have a higher relative risk of developing diabetes and coronary heart disease.5 Obese women are more likely to have risk of developing osteoarthritis in the knees and low back pain. Obesity and overweight have been linked to a higher risk of preterm deliveries, cesarean sections, poor birth outcomes, and infant mortality in women of childbearing age.8
The epidemiology of obesity in females needs to be monitored in order to gain a better understanding of the pathophysiology and risk factors associated with the condition, as the rate of increase in obesity continues to rise globally. This in turn could be used to create treatment and prevention plans tailored to each gender.10
Materials and methods:
The study was started after obtaining approval from Institutional Scientific and Ethics committee. The study was conducted in OPD at Madras Medical College. Females between 18-50 years were included in the study. The sample included 25 obese females with BMI >30 as cases and 25 non-obese females with BMI between 18.5 to 24.9 as controls based on the BMI classification of WHO. Detailed past medical and surgical history were taken and both groups were given the Long last 7 days self-administered IPAQ which contains a total of 27 questions enquiring about time spent in physical activity in the last 7 days. Using SPSS software the obtained data was analyzed.
Inclusion criteria:
1. Females
2. Age 18-50 years
3. BMI between 18.5 to 24.9 and BMI >30
Exclusion criteria:
1. Age <18 &> 50 years.
2. Males
3. BMI less than 18.5 and BMI between 25-29.9
4. Pregnant and lactating females
5. Females with H/O Cardiovascular disorders, Diabetes, Thyroid disorder, Psychiatric illness and Autonomic neuropathy.
The participants were explained about the aim of the study and informed consent was obtained before the start of the study. The questionnaire was clearly explained in simple, comprehensible words to give a better knowledge to those who had difficulty in understanding the questions. Based on the information obtained from the questionnaire, categorical score was given with category I being inactive, category II minimally active and category III as Health Enhancing Physical Activity (HEPA). The gathered datawas entered and tabulated in Microsoft Excel and analysis done with SPSS software.
Results:
The statistical test used in this study to compare the mean of two groups was unpaired t-test. The mean age, height, weight, and BMI of two groups were compared as shown in table 1. The mean age, weight and BMI were significantly higher among cases and the mean height was significantly higher among the controls. To find the association between physical activity and obesity in this study Fisher exact chi square test was used, as shown in table 2. It showed a significant p value of 0.0001, as the number of females involved in health enhancing physical activity i.e., at least 1.5- 2 hours of being active throughout the day, was less among obese females.
Table 1: Mean of two groups – Cases and Controls
Variables Obese (n=25) Non – Obese (n=25) p-value
Age (years) 36.04 ± 7.37 31 ± 8.5 0.0298
Height (cm) 154.72 ± 3.0 157.24 ± 2.8 0.0035
Weight (Kg) 75.48 ± 3.40 54.08 ± 4.06 0.0001
BMI 31.60 ± 1.36 21.86 ± 1.61 0.0001
P= <0.05 (significant)
Table 2: Association between physical activity and obesity- Fischer Exact Chi square test
Variables Inactive Minimally active Health Enhancing Physical Activity p-value
Obese 10 13 2 0.0001
Non obese 4 7 14
P= <0.05 (significant)
The following pie chart depicts the percentage of inactivity, minimal activity and Health enhancing physical activity engaged by obese and normal weight females.
Discussion:
The incidence of obesity-related cardiovascular disease (CVD) rises in conjunction with the global obesity prevalence. The year 2015 saw CVD, which is associated with a high BMI, emerge as the primary cause of mortality and disability-adjusted life years. For women in particular, the link between obesity and CVD has significant consequences. Women’s deaths from CVD are the main cause of death in the major developed nations as well as the majority of emerging nations. The phenomena of women being shielded from hypertension until a later age is associated with the vasodilatory benefits of estrogens. Because the age at which hypertension begins and BMI have an inverse relationship, obesity counteracts the benefits of estrogen and breaks it shielding effect on Hypertension.10 Enlightening women about the health advantages of physical activity is one of the easiest and most efficient strategies for combating these negative impacts of obesity.
It takes a rigorous method to measure every kind of physical activity and figure out the energy cost related to each particular type and level of physical activity in order to examine the physical activity. The purpose of the International Physical Activity Questionnaire (IPAQ) is to quantify people’s physical activity levels and associated metabolic equivalents (METs).17 Numerous techniques have been devised to ascertain an individual’s degree of physical activity. There is, however, little data to determine if a person is physically active or not. Accurately estimating physical activity is a challenging task due to its complexity.18
The International Physical Activity Questionnaire, the Global Physical Activity Questionnaire (GPAQ), and the physical activity diary are the available methods. Physical activity is accurately tracked by IPAQ (18).The International Physical Activity Questionnaire (IPAQ), which was used in this study, appears to be the most reliable method among many attempts to determine the indices of physical activity, useful in group comparisons as well as in individual counseling. It is the only reliable method in large-scale surveys in developed or developing countries.20
The American Physical Activity Guidelines stipulate that a minimum of 150 minutes a week of moderate physical activity, sustained in 10-minute or longer bursts, must be accrued each week. Thus, it has been suggested that engaging in this kind of prolonged moderate-to-intense physical activity (MVPA) is a healthy habit that has a positive impact on many health outcomes.13 This study aims at proving the fact that there is lack of physical activity and also there is very little awareness about the essential benefits of physical activity especially among women.
IPAQ-INTERNATIONAL PHYSICAL ACTIVITY QUESTIONNAIRE
PART 1: JOB-RELATED PHYSICAL ACTIVITY
The first section is about your work. This includes paid jobs, farming, volunteer work, course work, and any other unpaid work that you did outside your home.
Do not include unpaid work you might do around your home, like housework, yard work, general maintenance, and caring for your family. These are asked in Part 3.
1. Do you currently have a job or do any unpaid work outside your home?
Yes
No Skip to PART 2:TRANSPORTATION
The next questions are about all the physical activity you did in the last 7 days as part of your paid or unpaid work. This does not include traveling to and from work.
2. During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, heavy construction, or climbing up stairs as part of your work? Think about only those physical activities that you did for at least 10 minutes at a time.
days per week
No vigorous job-related physical activity Skip to question4
3. How much time did you usually spend on one of those days doing vigorous physical activities as part of your work?
hours per day
minutes per day
4. Again, think about only those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do moderate physical activities like carrying light loads as part of your work? Please do not include walking.
days per week
No moderate job-related physical activity Skip to question6
5. How much time did you usually spend on one of those days doing moderate physical activities as part of your work?
hours per day
minutes per day
6. During the last 7 days, on how many days did you walk for at least 10 minutes at a time as part of your work? Please do not count any walking you did to travel to or from work.
days per week
No job-related walking Skip to PART 2: TRANSPORTATION
7. How much time did you usually spend on one of those days walking as part of your work?
hours per day
minutes per day
PART 2: TRANSPORTATION PHYSICAL ACTIVITY
These questions are about how you traveled from place to place, including to places like work, stores, movies, and so on.
8. During the last 7 days, on how many days did you travel in a motor vehicle like a train, bus, car, or tram?
days per week
No traveling in a motor vehicle Skip to question10
9. How much time did you usually spend on one of those days traveling in a train, bus, car, tram, or other kind of motor vehicle?
hours per day
minutes per day
Now think only about the bicycling and walking you might have done to travel to and from work, to do errands, or to go from place to place.
10. During the last 7 days, on how many days did you bicycle for at least 10 minutes at a time to go from place to place?
days per week
No bicycling from place to place Skip to question12
11. How much time did you usually spend on one of those days to bicycle from place to place?
hours per day
minutes per day
12. During the last 7 days, on how many days did you walk for at least 10 minutes at a time to go from place to place?
days per week
No walking from place to place Skip to PART 3: HOUSEWORK,
HOUSE MAINTENANCE, AND CARING FOR FAMILY
13. How much time did you usually spend on one of those days walking from place to place?
hours per day
minutes per day
PART 3: HOUSEWORK, HOUSE MAINTENANCE, AND CARING FOR FAMILY
This section is about some of the physical activities you might have done in the last 7 days in and around your home, like housework, gardening, yard work, general maintenance work, and caring for your family.
14. Think about only those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, chopping wood, shoveling snow, or digging in the garden or yard?
days per week
No vigorous activity in garden or yard Skip to question16
15. How much time did you usually spend on one of those days doing vigorous physical activities in the garden or yard?
hours perday
minutes perday
Again, think about only those physical activities that you did for at least 10 minutes at a time.
16. During the last 7 days, on how many days did you do moderate activities like carrying light loads, sweeping, washing windows, and raking in the garden or yard?
days per week
No moderate activity in garden or yard Skip to question18
17. How much time did you usually spend on one of those days doing moderate physical activities in the garden or yard?
hours per day
minutes per day
18. Once again, think about only those physical activities that you did for at least 10minutes at a time. During the last 7 days, on how many days did you do moderate activities like carrying light loads, washing windows, scrubbing floors and sweeping inside your home?
days per week
No moderate activity inside home Skip to PART 4: RECREATION,
SPORT AND LEISURE-TIME PHYSICAL ACTIVITY
19. How much time did you usually spend on one of those days doing moderate physical activities inside your home?
hours per day
minutes per day
PART 4: RECREATION, SPORT, AND LEISURE-TIME PHYSICAL ACTIVITY
This section is about all the physical activities that you did in the last 7 days solely for recreation, sport, exercise or leisure. Please do not include any activities you have already mentioned.
20. Not counting any walking you have already mentioned, during the last 7 days, on how many days did you walk for at least 10 minutes at a time in your leisure time?
days per week
No walking in leisure time Skip to question22
21. How much time did you usually spend on one of those days walking in your leisure time?
hours per day
minutes per day
22. Think about only those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do vigorous physical activities like aerobics, running, fast bicycling, or fast swimming in your leisure time?
days per week
No vigorous activity in leisure time Skip to question24
23. How much time did you usually spend on one of those days doing vigorous physical activities in your leisure time?
hours per day
minutes per day
24. Again, think about only those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do moderate physical activities like bicycling at a regular pace, swimming at a regular pace, and doubles tennis in your leisure time?
days per week
No moderate activity in leisure time Skip to PART 5: TIMESPENT
SITTING
25. How much time did you usually spend on one of those days doing moderate physical activities in your leisure time?
hours per day
minutes per day
PART 5: TIME SPENTSITTING
The last questions are about the time you spend sitting while at work, at home, while doing course work and during leisure time. This may include time spent sitting at a desk, visiting friends, reading or sitting or lying down to watch television. Do not include any time spent sitting in a motor vehicle that you have already told me about.
26. During the last 7 days, how much time did you usually spend sitting on a week day?
hours per day
minutes per day
27. During the last 7 days, how much time did you usually spend sitting on a weekend day?
hours per day
minutes per day
Conclusion:
This study was focused on level of physical activity among females, as females were expected to have an almost two-fold greater obesity rate than males. This gender discrepancy could be attributed to the sort of physical activity engaged in, with males engaging in strenuous physical exercise more frequently than females. The study shows positive association between physical inactivity and obesity among females which may lead to various cardiovascular, metabolic and reproductive abnormalities. The risk of these comorbidity can be decreased by encouraging physical exercise and educating them about the potential benefits that can be obtained from it. Hence physical activity should be regarded as a crucial preventive measure that can be taken against these many abnormalities.
Limitations:
The study’s minuscule sample size was one of its main drawbacks. The samples in this study were divided into cases and controls based on BMI. The BMI is an overly simplistic metric to detect obesity because it solely takes into account height and weight. It is unable to differentiate between excess fat, muscle, or bone mass since it does not account for the weight of the muscular mass. There is no clue regarding the distribution of fat using BMI. A bigger sample size and the use of the waist-hip ratio in addition to the BMI to obtain precise information regarding the existence of centripetal fat would have improved this study.
Acknowledgements: Nil
Conflict of interest: Nil
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