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.

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