Physical Activity And Physical Fitness For School Students
Outline
• Physical activity VS. physical fitness
• Benefits and Advantages
• Measurement of physical activity
• Measurement of physical fitness
• Physical Fitness among Secondary School Students in Central Zone, Malaysia: MyHEARTS
Physical Activity1 • Any movement produced by
skeletal muscles that results in energy expenditure
• Leisure, occupational, exercise
• Exercise is a subset of physical activity
• planned, structured, and repetitive →aims to maintain or improve one component of fitness
Physical Fitness1
• the ability to carry out daily tasks with vigour and alertness, without undue fatigue and with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies
Components of Physical Fitness •Cardio-respiratory fitness
•Muscular endurance
•Muscular strength
•Body composition
• Flexibility
Benefits of Physical Activity and Fitness in Children Parameters Study Group Results
Body fat 2-6 Cross sectional & longitudinal studies - Overweight Active VS Overweight Sedentary
High levels physical activity → Less Adiposity
Metabolic Syndrome7-9
Cross sectional & RCT - Obese and Non-obese
Moderate to vigorous exercise → Improves TG, fasting insulin, adiposity
Lipid Profile9-11 Intervention - RCT & Non RCT Weak beneficial of regular moderate to vigorous physical activity • ↑ HDL-C • ↓ TG levels, • No changes on total
cholesterol & LDL-C
Parameters Study Group Results
Blood Pressure12-16 Young HPT • Aerobic activities positive effect
• Add in strength training prevents return to pre intervention levels
• Strength training alone has no effect
Mental Health17-22 Cross sectional and quasi-experimental design (causality?)
↑measures of anxiety and depression score
Academic results23-27 Cross sectional & quasi-experimental studies
• ↑ academic performances, memory, concentration, classroom behaviour, & intellectual performances
Parameters Study Group Results
Strength 28-29 Longitudinal studies ↑ upper body strength
Bone Mineral30-35 Case studies & retrospective studies • Active VS inactive,
elite young athletes VS less active youth
↑ bone mineral content, bone mineral density, and bone mineral apparent density
Malaysian Children & Adolescent • Aboshkair, K.A. et all (2012)36 – cross sectional study, 918
participants from 38 secondary schools in Selangor • all fitness assessment tests (push up, sit-up, sit-and-reach & 20m
shuttle run) performances negatively associated with BMI for both genders
• Rengasamy, S. (2012)37 – quasi-experimental school based intervention program (girls school) • After 10 weeks exercise program (2x/week) – the intervention
group significantly improve their aerobic and flexibility; no significance in muscular strength between groups
• Zalilah, M.S. et al (2006)38 – cross sectional study, 6555 secondary school • No significant difference of time spent for physical activity among
underweight, normal and overweight
Physical Activity Measurement
• Questionnaire
• Accelerometer
QUESTIONNAIRE
• Physical Activity Questionnaire (PAQ):
• For Older Children (PAQ-C)39 → ages 8-14
• For Adolescents (PAQ-A)39 →ages 14-20
• Self-administered, 7-day recall questionnaires
• Evaluates the sports, leisure activities, and games performed throughout school days, evenings, and weekends
STRENGTH
i. High validity and moderate reliability
ii. Cost and time efficient
iii. Easy to administer for mass population
iv. Measures general physical activity levels of children to adolescent
LIMITATIONS
i. No estimation of energy expenditure.
ii. No differential of activity intensities → a summary activity score
iii. Only appropriate when used during the school year
iv. Recall bias
• Scoring
• A score of 1 indicates low physical activity, whereas a score of 5 indicates high physical activity
ACCELEROMETER
• Objectively measure activities and predicts energy expenditure
• Using body worn sensors
ACCELEROMETER
• Provides objective data
• Captures “real-time” intensity, duration, and can derive frequency of bouts
• leisure, occupational, sports/ exercise, sitting, lying down, sleeping
• Can monitor multiple days with low burden
• Relatively small and lightweight
ACCELEROMETER
• Expensive
Accelerometer
Physical Fitness Measurement
• Laboratory Exercise Testing
• Field testing
Laboratory Exercise Testing
• Laboratory setting
• Skilled technician
• Measure of maximal O2 uptake (VO2 max)
Equipments
• Treadmill (protocols – Bruce, Balke-Ware, Naughton)
• Cycle ergometer (Astrand protocol)
• Automated BP monitoring
• ECG recording system
• Ventilation mask – measure O2 consumption & CO2 production
On Field Testing
• Walk test
• Shuttle test
• Step test
Walk Test
• Walk at their maximal effort
• Divided into 2
• Time based : 2 min, 6 min, 12 min
• primary outcome measure is distance
• walk as far as possible in the specified time
• Distance based : 400m walk test, 1 mile walk test
• primary outcome measure is time
• Walk at required distance as quickly as possible at a pace that they can maintain
Shuttle Test
• Incremental exercise tests require children to walk or run at increasing speeds back and forth a 10-m or 20-m course (marked by cones)
• Speed is increased and subsequent interval is shortened every minute and is controlled by audio signals played from a tape
• Test is terminated when the participant chooses to stop or when on 2 consecutive paced signals the patient is more than 1 m away from the closest marker
• Divided into Shuttle walk test (10m) and shuttle run test (20m)
• Participants motivation is a very important factor to achieve a valid test
• Require a big space/venue/long corridor
Step Test
• Participant step up and down from a platform/bench/stool
• Participant maintain pace at a set stepping rate for a specified time period
• Thus this test is relatively free of the variability associated with patient motivation
• Primary outcome measure is post exercise heart rate
Step Test
• Relatively easy, simple, cheap and portable
• Does not require as much space as other field test
• Minimal expertise is needed
• Stepping skill requires little practice
• Equipment
• Bench/stool/step box (vary in heights depending on protocol)
• Stop Watch
• Metronome (set pace stepping rate)
Step test
• YMCA/Kasch Step test
• One of the most widely used (Malaysia SEGAK : Standard Kecergasan Fizikal Kebangsaan)
• Bench 30 cm , cadence of 96 beats per minute, total 3 minutes
• Within 5 seconds following test , the child was seated and heart rate was palpated for 60 seconds via radial pulse. The number of beats per minute (BPM) was recorded.
3 Limitations
18-25 26-35 36-45 46-55 56-65 65+
Excellent 52-81 58-80 51-84 63-91 60-92 70-92
Good 85-93 85-92 89-96 95-101 97-103 96-101
Above Average 96-102 95-101 100-104 104-110 106-111 104-111
Average 104-110 104-110 107-112 113-118 113-118 116-121
Below Average 113-120 113-119 115-120 120-124 119-127 123-126
Poor 122-131 122-129 124-132 126-132 129-135 128-133
Very Poor 135-169 134-171 137-169 137-171 141-174 135-155
Modified Harvard Step Test
• This step test is one of the tests that categorizes the
fitness level in children
• Equipment
1.30 cm bench/stool
2.Stop watch
3.Metronome set at 120bpm
4.Finger pulse oximeter / Polar heart rate monitor →
continuously heart rate monitoring
Modified Harvard Step Test
1.Using a stop watch and metronome, the child was asked to
step onto (both feet) and off a stool/ bench 30 cm high for
total of 5 minutes.
2.The student paced at 120 beats per minute
3.Students whose heart rates reached 200 beats per minute,
who had difficulty in breathing, or who were unable to finish
were stopped
4.Once the student has completed the step test or was stopped
due to the above reasons stated in 3, the student quickly sits
down on the bench and rest.
Modified Harvard Step Test
5. Heart rate is recorded at 0, 1, and 2 minutes post
exercise
6. Total exercise duration is recorded in seconds
7. Physical Fitness Score (PFS) is calculated by dividing the
total time of exercise in seconds by the sum of three heart
rate values measured at 0, 1 and 2 minutes post exercise
Physical Fitness Score
<55 55-64 65-79 80-89 ≥90
Poor Low Average High Average Good Excellent
MyHEARTS
• Malaysian Health and Adolescents Longitudinal Research Study (MyHEARTS)
• Objective :
• identify the trends of prevalence of non-communicable diseases’ risk factors among adolescents in Peninsular Malaysia
• to determine how lifestyles in early adolescence influence development of chronic non-communicable disease in early adulthood
• Study area – conducted in the central zone of Peninsular Malaysia – 3 states : Perak, Selangor & KL
• Cross sectional cohort study – form 1 (age 13), both male & female, studying government schools, understand and read BM
Physical Fitness among Secondary School Students in Central Zone, Malaysia : MyHEARTS
• Total number of schools: 15
• Total number participants for step test : 1071
• 405 boys, 666 girls
Redzal Abu Hanifah1, Mohd. Nahar Azmi Mohamed
1, Tin Tin Su
2, Nabilla Al-Sadat Abdul
Mohsein2, Muhammad Yazid Jalaludin
3, Liam Murray
4, Hazreen Abdul Majid
2
1 Sports Medicine Clinic, University Malaya Medical Centre, Kuala Lumpur, Malaysia
2 Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala
Lumpur, Malaysia. 3 Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
4Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen’s
University, Belfast, Northern Ireland
Physical Fitness Score (PFS)
Category n (%)
Poor 11.5
Low Average 32.2
High Average 47.2
Good 6.7
Excellent 2.3
Unacceptable (43.7%)
Marginally acceptable (47.2%)
Acceptable (9.0%)
Physical Fitness Score (PFS) Gender Categories Boys (%) Girls (%)
Unacceptable 18.8 81.2
Marginally Acceptable 46.1 53.9
Acceptable 86.6 13.4
• Malaysian Association for Physical Education, Sports Science and Fitness (MAPESSF, 2008) :
“..inactivity among Malaysian schoolchildren is due to the shortage in sports facilities, lack of opportunities for the children to be active, and lack of PE teachers in Malaysian schools,… together with an unsupportive school environment…”
Exercise Prescription for Children • Minimal amount of physical activity needed to achieve
the various components of health-related fitness
• ACSM recommendation : • F requency: At least 3–4 days per week and preferably daily.
• I ntensity: Moderate (physical activity that noticeably increases breathing, sweating, and HR) to vigorous (physical activity that substantially increases breathing, sweating, and HR) intensity.
• T ime: 30 min per day of moderate and 30 min per day of vigorous intensity to total 60 min per day of accumulated physical activity.
• T ype: A variety of activities that are enjoyable and developmentally appropriate for the child or adolescent; these may include walking, active play/games, dance, sports, and muscle- and bone-strengthening activities.
References 1. Caspersen, C.J. et al, Physical Activity, Exercise, and Physical Fitness: Definitions and Distinctions for Health-Related
Research, Public Health Rep. 1985 Mar-Apr; 100(2): 126–131
2. Berkey CS, Rockett HR, Field AE, Gillman MW, Frazier AL,Camargo CA Jr, et al. Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics 2000;105:E56.
3. Ekelund U, Aman J, Yngve A, Renman C, Westerterp K, Sjostrom M. Physical activity but not energy expenditure is reduced in obese adolescents: a case-control study. Am J Clin Nutr 2002;76:935-41.
4. Eisenmann JC, Bartee RT, Wang MQ. Physical activity, TV viewing, and weight in US youth: 1999 Youth Risk Behavior Survey. Obes Res 2002; 10:379-85.
5. Kawabe H, Murata K, Shibata H, Hirose H, Tsujioka M, Saito I, et al. Participation in school sports clubs and related effects on cardiovascular risk factors in young males. Hypertens Res 2000;23:227-32.
6. Lazzer S, Boirie Y, Bitar A, Montaurier C, Vernet J, Meyer M, et al. Assessment of energy expenditure associated with physical activities in free living obese and nonobese adolescents. Am J Clin Nutr 2003;78:471-9.
7. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003;157:821-7.
8. Torok K, Szelenyi Z, Porszasz J, Molnar D. Low physical performance in obese adolescent boys with metabolic syndrome. Int J Obes Relat Metab Disord 2001;25:966-70.
9. Pinhas-Hamiel O, Standiford D, Hamiel D, Dolan LM, Cohen R, Zeitler PS. The type 2 family: a setting for development and treatment of adolescent type 2 diabetes mellitus. Arch Pediatr Adolesc Med 1999;153: 1063-7.
10. Stoedefalke K, Armstrong N, Kirby BJ, Welsman JR. Effect of training on peak oxygen uptake and blood lipids in 13- to 14-year-old girls. Acta Paediatr 2000;89:1290-4.
11. Cohen CJ, McMillan CS, Samuelson DR. Long-term effects of a lifestyle modification exercise program on the fitness of sedentary, obese children. J Sports Med Phys Fitness 1991;31:183-8.
12. Ewart CK, Young DR, Hagberg JM. Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension. Am J Public Health 1998;88:949-51
13. Danforth JS, Allen KD, Fitterling JM, Danforth JA, Farrar D, Brown M, et al. Exercise as a treatment for hypertension in low-socioeconomic-status black children. J Consult Clin Psychol 1990;58:237-9.
14. Hagberg JM, Goldring D, Ehsani AA, Heath GW, Hernandez A, Schechtman K, et al. Effect of exercise training on the blood pressure and hemodynamic features of hypertensive adolescents. Am J Cardiol 1983;52: 763-8.
15. Hagberg JM, Ehsani AA, Goldring D, Hernandez A, Sinacore DR, Holloszy JO. Effect of weight training on blood pressure and hemodynamics in hypertensive adolescents. J Pediatr 1984;104:147-51.
16. Laird WP, Filxer DE, Swanborn CD. Cardiovascular effects of weight training in hypertensive adolescents. Med Sci Sports Exerc 1979;11:79
17. Brown JD, Lawton M. Stress and well-being in adolescence: the moderating role of physical exercise. J Human Stress 1986;12:125-32.
18. Brown JD, Siegel JM. Exercise as a buffer of life stress: a prospective study of adolescent health. Health Psychol 1988;7:341-53.
19. Norris R, Carroll D, Cochrane R. The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population. J Psychosom Res 1992;36:55-65.
20. Kirkcaldy BD, Shephard RJ, Siefen RG. The relationship between physical activity and self-image and problem behaviour among adolescents. Soc Psychiatry Psychiatr Epidemiol 2002;37:544-50.
21. Steptoe A, Butler N. Sports participation and emotional wellbeing in adolescents. Lancet 1996;347:1789-92.
22. Hilyer J, Wilson DG, Dillon C, Caro L. Physical fitness training and counseling as treatment for youthful offenders. J Couns Psychol 1982;29: 292-303
23. Pate RR, Baranowski T, Dowda M, Trost SG. Tracking of physical activity in young children. Med Sci Sports Exer 1996;28:92-6. 24. Dwyer T, Sallis JF, Blizzard L, Lazarus R, Dean K. Relationship of academic performance to physical activity and fitness in
children. Pediatr Exerc Sci 2001;13:225-37. 25. Hanson TL, Austin G. Student health risks, resilience and academic performance in California: year 2 report, longitudinal
analyses. Los Alamitos, Calif: WestEd; 2002. 26. Kim HY, Frongillo EA, Han SS, Oh SY, Kim WK, Jang YA, et al. Academic performance of Korean children is associated with
dietary behaviours and physical status. Asia Pac J Clin Nutr 2003;12:186-92. 27. California Department of Education. Academic achievement and physical fitness. California STAR Testing Program; 2002 28. Verschuur R. Daily physical activity and health: longitudinal changes during the teenage period. Doctoral dissertation,
University of Amsterdam; 1987. 29. Kemper H, van Mechelen W. Physical fitness and the relationship to physical activity. In: Kemper H, ed. The Amsterdam
Growth Study: a longitudinal analysis of health, fitness, and lifestyle. Champaign, Ill: Human Kinetics; 1995. p. 174-88 30. Afghani A, Xie B, Wiswell RA, Gong J, Li Y, Anderson JC. Bone mass of Asian adolescents in China: influence of physical activity
and smoking. Med Sci Sports Exer 2003;35:720-9. 31. Duppe H, Gardsell P, Johnell O, Nilsson BE, Ringsberg K. Bone mineral density, muscle strength and physical activity: a
population-based 32. study of 332 subjects aged 15-42 years. Acta Orthop Scand 1997;68:97-103. 33. Elgan C, Dykes AK, Samsioe G. Bone mineral density and lifestyle among female students aged 16-24 years. Gynecol
Endocrinol 2002;16:91-8. 34. Ilich JZ, Skugor M, Hangartner T, Baoshe A, Matkovic V. Relation of nutrition, body composition and physical activity to
skeletal development: a cross-sectional study in preadolescent females. J Am Coll Nutr 1998;17: 136-47. 35. Nordstrom P, Thorsen K, Nordstrom G, Bergstrom E, Lorentzon R. Bone mass, muscle strength, and different body
constitutional parameters in adolescent boys with a low or moderate exercise level. Bone 1995;17:351-6. 36. Aboshkair, KA, et al, Relations between Health-Related Physical Fitness, Physical Activity, and BMI among children in
Selangor, Malaysia, Wulfenia J 2012, 19 (10): 67-81 37. Rengasamy, S, A physical intervention program within a physical education class on selected health-related fitness among
secondary school students, Procedia - Social and Behavioral Sciences 55 ( 2012 ) 1104 – 1112 38. Zalilah, MS, et al , Dietary intake, physical activity and energy expenditure of Malaysian adolescents, Singapore Med J 2006;
47(6) : 491 39. Kowalski, KC et al, The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual, College
of Kinesiology, University of Saskatchewan, Canada (Aug 2004): 1-37