Applied Research Quality Life (2014) 9:887–896 DOI 10.1007/s11482-013-9275-1
Physical Activity in Overweight and Obese Women: Association with Body Mass Index and Demographic Characteristics Reza Mahdavi & Zeinab Nikniaz & Alireza Ostadrahimi & Leila Nikniaz
Received: 6 January 2013 / Accepted: 27 October 2013 / Published online: 16 November 2013 # Springer Science+Business Media Dordrecht and The International Society for Quality-of-Life Studies (ISQOLS) 2013
Abstract The aim of present study was determination of the level of physical activity in overweight and obese women and its association with body mass index and various socio-demographic characteristics. In the present cross-sectional survey, the translated and validated form of International physical activity questionnaire was completed by 300 overweight and obese women from Iran-Tabriz. For each activity level, the METtime value was calculated. The weight and height of subjects were measured and the BMI was calculated. In addition, subjects were asked to indicate their age, marital and socioeconomic status (including employment, educational status, salaries and material endowments) using a general information questionnaire. The One-way ANOVA, Independent t-test, multiple linear regression analysis were used for statistical analysis. Approximately, 45 % of women were physically inactive. Overweight women were more likely to be physically active as compared to obese, while the lowest physical activity rates were observed in older participants. With increasing age, the time spent in vigorous physical activity declined significantly (p-value=0.004). Physically active women had higher Socio-economic status. The average time spent on vigorous physical activities were significantly more in single than married women (p-value<0.001). Considering the high level of inactivity among studied women, intensive public health efforts together with providing facilities within neighborhoods, are needed to improve women participation in physical activities. R. Mahdavi : A. Ostadrahimi Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Z. Nikniaz (*) Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran e-mail:
[email protected] L. Nikniaz Nutrition Faculty, Tabriz university of medical Sciences, Tabriz, Iran
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Keywords Body mass index . Obese . Overweight . Physical activity . Women
Introduction Obesity is a multi-factorial problem, which was resulting from changing of social, economic and physical environments that have led to an energy imbalance through changes in dietary patterns (World Health Organization 2003a and Maffeis 2000) and reduction in physical activity (Steinbeck 2001 and Riddoch et al. 2004). A decrease in daily physical activity has contributed to the increased prevalence of obesity worldwide (Grundy et al. 1999; Ross and Janssen 2001). Consequently, limited studies also suggested that an increase in physical activity without caloric restriction is a useful strategy for reducing obesity (Ross et al. 2000a, b). Besides, several observational and clinical studies suggest that physical activity contributes to healthy bones, muscles, and joints, reduces falls among older adults, helps to relieve the pain of arthritis and is associated with fewer hospitalizations, physician visits, medications (US Department of Health and Human Services 1999) and finally higher levels of Physical activity are associated with better Health related quality of life (Vuillemin et al. 2005 and Anokye et al. 2012). In this regard, the Center for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) recommend that all adults should engage in at least 30 min of moderate physical activity on 5 or more days of the week or at least 20 min of vigorous physical activity on 3 or more days of the week to reduce the risk of chronic illness (Centers for Disease Control and Prevention and U.S. Department of Health and Human Services 1996 and Pate et al. 1995). However, despite the proven benefits of physical activity, the World Health Organization (WHO) estimates that 60 % of adults are not active enough to benefit their health (World Health Organization 2003b). Also the national study on Iranian adults has been reported that approximately 80 % of Iranian adults were physically inactive and women were more likely than men to report no leisure-time activity (Sheikholeslam et al. 2004). There are many factors including demographic, psychosocial, physical environmental, and policy factors assumed to have influence on physical activity amount. Considering the lack of data regarding the amount of physical activity and its association with various characteristics of overweight and obese women, and also because of the Iran’s special cultural and religious status, this study was conducted with the aim of evaluating the amount of physical activity in overweight and obese Iranian women and to investigate its association with body mass index and various socio-demographic characteristics.
Materials and Methods In the present cross-sectional study a total of 300 overweight and obese volunteered women recruited from an outpatient clinic on primary and referred patients belonging to Tabriz University of Medical Sciences by convenience sampling from March to June 2011. Subjects were included if they had age between 18 and 65 years, BMI over 25 kg/m2, not being athletes, pregnant or breastfeeding.
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Body-weight was measured to the nearest 0.1 kg on a Seca digital weighing scale, and height was measured to the nearest cm, with bare feet using a stadiometre. Body mass index (BMI) was calculated from body-weight and height (kg/m2). The WHO definition of overweight as BMI of 25–29.9 kg/m2 and obesity class I as a BMI of 30–34.99, class II as a BMI of 35–39.99 and class III as BMI of greater than 40 was used. Subjects were asked to indicate their age, marital and socioeconomic status (including employment, educational status, salaries and material endowments) using a general information questionnaire. Physical activity amount was measured using a translated and short version of International physical activity questionnaire (IPAQ). The validity of the translated form of this questionnaire was tested in the previous study on Iranian subjects (AsheghaniFarahani et al. 2011). In a pilot study, the test-retest reliability of questionnaire was tested in a random sample of 30 women and it had accepted intraclass correlation coefficient (ICC > 0.7). Physical activity levels were also classified into three categories: inactive, minimally active and health-enhancing physically active, according to the scoring system provided by the IPAQ (Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire—Short and Long Forms 2005). The questionnaires were administered by a trained professional researcher and women were required to determine the type, the number of days in the week and also the time spent on each activity. For each activity level, the MET-value was multiplied by the time spent at that particular level in a week. The MET-time at each level was added to obtain a total over 1 week MET-time. Statistical Analysis Participants’ characteristics were described using mean and standard deviations for continuous variables and frequency and percentages for categorical variables. One-way ANOVA was used to compare the mean amount of physical activity across different age, BMI and socioeconomic status (SES) groups. Independent t-test was used to compare the mean amount of physical activity in married and single women. Pearson correlations between amount of physical activity, age and BMI and also spearman correlations between amount of physical activity, SES and marital status were calculated. Finally using a multiple linear regression analysis, the association between the amount of physical activity (as a dependent factor) and demographic variables such as marital and SES and also BMI (as an independent factor) was assessed.
Results Table 1 outlines the demographic and anthropometric characteristics of 300 overweight and obese women. Mean age of participants was 34.04 ± 10.67 ranging from 18 to 52 years. The mean weight for participants was 80.4±13.7 kg and BMI was 32.0±5.4 kg/m2. Approximately 33 % of subjects had a college degree, 22.33 % were currently employed, and 79 % were married. Table 2 summarizes the physical activity profile of subjects, based on three activity categories. More than 45 % of the subjects were physically inactive, whereas only about 3 % were active. More overweight females were engaged in physical activities compared to obese subjects.
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Table 1 Anthropometric and demographic characteristics of subjects (n=300)
Continuous variables
Mean
SD
Age (years)
34.04
10.64
Weight (kg)
80.45
13.78
Height (cm)
158.62
5.92
BMI* (kg/m2)
32.0
5.40
Categorical variables
frequency
percentage
25–29.99
104
34.66 %
30–34.99
112
37.33 %
35.39.99
52
17.33 %
>40
32
10.66 %
Married
273
79 %
Employed
67
22.33 %
Unemployed
195
65 %
Student
38
12.66 %
High school or low
201
67 %
BSc degree
90
30 %
MSc/Ph.D degree
9
3%
BMI* categories
Employment status
Education:
Socio-economic status Low
142
47 %
Medium
99
33 %
High
60
20 %
*BMI body mass index
The mean amount of time spent on physical activity in overweight and obese women in different age, BMI, SES and marital groups are shown in Table 3. The overall trend Table 2 Physical activity profile of the study subjects Activity category
Total (n=300)
Overweight (n=104)
Obese (n=196)
Inactivea* (%)
45.5
39.2
49.6
Minimally activeb (%)
50.5
55.7
47.1
4
5.1
3.3
Activec (%) a
Not meeting criteria for minimally active or active
b
Meeting any of the following conditions: 1) participating in 3 or more days of vigorous-intensity activity for at least 20 min per day, or 2) participating in 5 or more days of moderate intensity activity or walking for at least 30 min per day, or 3) participating in 5 or more days of any combination of walking, moderate-intensity or vigorous-intensity activities achieving a minimum of at least 600 MET-min per week (MET = metabolic equivalent)
c
Meeting either of the following criteria: 1) vigorous-intensity activity on at least 3 days achieving at least 1500 MET-min per week, or 2) taking part in 7 or more days of any combination of walking, moderateintensity or vigorous-intensity activities achieving a minimum of at least 3000 MET-min per week
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Table 3 The mean amount (minute/week) of physical activity among overweight and obese subjects (n=300) Sedentary (<3MET)
moderate (MET = 3–6)
vigorous (MET > 6)
Total
18–25
11.72±37.16
236.88±217.16
53.04±100.75
301.64.±243.20
26–35
13.23±39.20
154.28±203.89
18.73±51.84
190.40±240.41
36–45
6.25±25.48
186.69±166.92
22.68±63.81
215.62±176.99
168.47±166.73
0
169.31±166.23
0.191
0.004
0.02
Age
>45 P-value*
0.84±3.51 0.269
Body mass index 25–29.9
9.97±33.50
214.41±211.46
23.15±57.34
244.76±241.11
30–34.99
8.50±31.87
196.94.±204.27
26.30±61.96
232.73±223.64
35–39.99
11.61±39.25
151.16±149.26
3.52±14.55
97.94±143.17
>40 P-value*
0.942
20.22±90.92
183.00±181.07
0
101.47±153.54
0.190
0.131
0.137
Socio-economic status Low
4.59±18.31
167.58.±176.21
19.30±54.24
192.00±183.52
Moderate
9.13±33.67
186.66±192.65
37.01±84.30
233.35±233.05
High
19.57±49.39
224.40±229.71
14.25±58.81
258.22±267.78
P-value*
0.502
0.303
0147
0.231 195.70±216.73
Marital status Married
9.87±34.28
171.89±197.14
13.48±34.85
Single
5.92±22.19
230.86±174.30
63.35±108.47
300.14±214.06
0.08
<0.001
0.06
P-value**
0.464
*p-value of one way ANOVA **P-value of Independent t-test
was for a decline in all types of physical activity with increasing age. With increasing age, the time spent in vigorous physical activity declined significantly (p-value=0.004). Also overweight subjects spent more time on moderate and vigorous physical activities than obese women. However, these differences were not statistically significant between various groups (P>0.05). The average number of minutes per week spent on moderate to vigorous physical activities was higher in women with the higher socioeconomic status. Besides Single women were more likely to spend time on physical activity than married ones and the average time spent on vigorous physical activities were significantly more in single than married women (p-value<0.001). The regression models for the association between the mean time spent on physical activity, age, BMI, SES and marital status were shown in Table 4. Higher amount of physical activity was found among 18- to 25-year-old participants (reference group) with respect to all other age groups. A significantly lower amount of physical activity was found in women with degree III obesity when compared to overweight women (reference group). Women from moderate and high socioeconomic status had higher amount of physical activity than subjects with low SES (reference group). Additionally,
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Table 4 Regression coefficient for the association between the amount of physical activity and BMI and demographic factors
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Beta
P-value**
Age 18–25
(ref*)
(ref)
26–35
−0.183
0.07
36–45
−0.071
0.48
>45
−0.139
0.15
Body Mass Index (BMI) 25–29.9
(ref)
(ref)
30–34.99
−0.005
0.94
35–39.99
−0.059
0.43
>40
−0.171
0.23
Socio-economic status (SES)
Regression model was adjusted for age, BMI, SES and marital status *ref reference group **p-value<.05
Low
(ref)
(ref)
Medium
0.145
0.04
High
0.126
0.09
Marital status Married
(ref)
(ref)
Single
0.152
0.06
remarkably lower amount of physical activity was observed in married women when compared to single subjects.
Discussion In this observational study of 300 overweight and obese women from Tabriz regionnorth west of Iran, we found that, approximately, one out of two women was physically inactive. As expected, overweight women were more likely to be physically active as compared to obese ones, while the lowest physical activity rates were observed in older participants (i.e. over 45 years old). A description of the profile of the participants showed that physically active people had higher SES and were more likely to be unmarried. More than 45 % of participants in the present study were inactive. This estimate is inline with the results of other studies in both developed and developing countries. In study in Saudi Arabia, more than 98 % of Saudi females were physically inactive (Al-Nozha et al. 2007). A Brazilian survey using the IPAQ short-form instrument also found inactivity prevalence of 41.8 % among Brazilian adult women aged 20 years and above (Hallal et al. 2003). In Australia (Burton and Turrell 2000) and the United States (Martin et al. 2000), the prevalence of leisure physical inactivity were 67.7 % and 68.0 %, respectively. Iranian women were reported to be inactive in earlier studies. A national survey had revealed that nearly 33 % of Iranian women were not physically active (Asgari et al. 2009). As in our study only obese individuals were included hence the prevalence of physical inactivity was found
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to be higher. It was reported that Iranian females were faced many barriers to an active lifestyle, including lack of suitable places to be active, access to facilities and resources, cultural limitations and the low importance placed on exercising over other activities such as household tasks (Taymoori et al. 2010). In the present study the overall trend was for a decline in physical activity with increasing age. The multiple linear regressions confirmed that, there was an inverse association between age and total physical activity. These results were in line with the results of other studies (Camoes and Lopes 2008; Chevan 2008 and Seabra et al. 2008). This may be due to increasing domestic and professional responsibilities, lack of awareness or poor health with increasing age (Schutzer and Graves 2004; Brownson et al. 2000; Cooper et al. 2001). Encouragement from physicians and household members may be effective in increasing physical activity among older obese people (Samir et al. 2011). Regarding BMI status, we observed that although there was no significant difference in the amount of time spent in physical activity across different BMI categories, overweight subjects spent more time on physical activity than obese participants. Besides, obese individuals tended to spend more time on watching TV than their overweight counterparts (data not shown). Because of the cross-sectional nature of our study, it cannot be determined whether obese individuals are less likely to participate in physical activity or whether sedentary lifestyle determines the anthropometric characteristics. In study on U.S. students, overweight girls were less likely to be involved with sports than girls of normal weight. This finding suggested that weight status is correlated with physical activity behavior (Levin et al. 2003). Feeling too fat to exercise has been identified as a common barrier among the overweight and obese (Ball et al. 2000). It is essential to educate overweight and obese people about the appropriate frequency and duration of physical activity. Thus, physicians and health care providers may be able to provide specific activity suggestions that might increase people enjoyment and encourage long-term participation in physical activities. Women with moderate and high socioeconomic status had higher amount of physical activity than subjects from low SES in the present study. Our finding is inline with the hypothesis that higher-income individuals are more likely to follow preventive programs and health-promoting behaviors (Dias-da-Costa et al. 2005). Physical activity has been related with social status in some, but not all studies. Several studies (Barrons and Nahas 2001; Macera et al. 1995) have shown that physical inactivity is inversely associated with socioeconomic status. Parkes (2006) showed that, lower income residents of USA were less likely than higher income residents to meet physical activity recommendations. In other studies in Denmark (Schnohr et al. 2004), Mexico (Hernandez et al. 2003) and Australia (MacDougall et al. 1997), the investigators reported that subjects with the lowest level of education were most frequently physically inactive. The finding that increasing education and income were associated with increasing levels of Leisure time physical activity is consistent with the theory that leisure time physical activity may be considered a commodity, requiring income and free time (Kandula and Lauderdale 2005). Regarding marital status, the results of the present study were in line with the results of study in Greece which showed that single participants were more likely to be physically active as compared to married ones (Pitsavos et al. 2005). Contrary to these results, in a population-based study of men and women from the US, the transition from a single to a married state resulted in significant positive changes in physical activity
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(King et al. 1998). Family, work and other social responsibilities, besides the cultural difference may be responsible for the differences of the results between these studies. As, there are very sparse data concerning the relationship between marital status and the amount of physical activity, this subject requires further investigations. We acknowledge that certain factors might influence the findings of the current study. This is a cross-sectional study that cannot provide causal relationships, but only state hypotheses for future research. Besides, data on physical activity were based on self-report without an objective measure of physical activity. Self-report can lead to recall bias. In conclusion, it was indicated that approximately one out of two overweight and obese women in Tabriz-Iran did not meet the minimal levels of physical activity necessary for health enhancement. The high prevalence of inactivity in this population represents a major public health concern. So, intensive public health efforts along with providing physical activity facilities within neighborhoods are needed to improve women’s participation in physical activities. Additionally it was illustrated that physical inactivity was more prevalent among older, obese, married and from low socioeconomic status women. So it seems that public health programs in promoting physical activity might be more successful if they considered the individual differences. So specific programs might be suggested for each subsections of target population for the adoption and adherence of non-participants and for the maintenance of those already engaged in physical activity. Acknowledgments The authors wish to thank the research vise-chancellor of Tabriz University of Medical Sciences for its financial supports and all the women who participate in this study.
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