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| ORIGINAL ARTICLE |
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| Year : 2015 | Volume
: 18
| Issue : 6 | Page : 790-795 |
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Self-reported physical activity among health care professionals in South-West Nigeria
SO Iwuala1, AO Sekoni2, MA Olamoyegun3, MA Akanbi4, AA Sabir5, OO Ayankogbe2
1 Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Lagos State, Nigeria
2 Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Lagos State, Nigeria
3 Department of Medicine, LAUTECH Teaching Hospital, College of Health Sciences, Ladoke, Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
4 Department of Medicine, University of Jos, Plateau State, Nigeria
5 Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| Date of Acceptance | 12-May-2015 |
| Date of Web Publication | 20-Aug-2015 |
Correspondence Address:
S O Iwuala
Department of Medicine, College of Medicine, University of Lagos, Idi. Araba, Lagos. PMB 12003
Nigeria
 Source of Support: Nil., Conflict of Interest: None  | Check |
DOI: 10.4103/1119-3077.163275
 Abstract | | |
Introduction:Physical activity (PA) is a key requirement for maintaining good health. There is growing evidence of declining PA worldwide. Physical inactivity is linked with the global obesity pandemic and increasing burden of noncommunicable diseases (NCDs) in developing countries. A barrier to PA counseling by health care providers (HCPs) is personal PA habits. Information regarding PA among HCPs in Nigeria is limited. We aimed to determine the adequacy and predictors of PA among HCPs of a tertiary health care facility in Lagos, Nigeria.
Methods: A cross-sectional study was carried out with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Using the World Health Organization (WHO) guideline, PA was categorized as adequate or inadequate. Predictors of PA were explored with multivariate logistic regression.
Results: A total of 300 HCPs were recruited, comprising 47.7% doctors and dentists, 43.3% nurses and 9.0% other HCPs. Mean age was 39.9 (9.0 years), 79.2%, 9.7% and 11.1% of the HCPs had low, moderate or high PA levels respectively. Thus, only 20.8% had adequate PA. 71.3% had body mass index (BMI) above the recommended value. BMI of ≥25 kg/m2 was associated with inadequate PA (Adjusted Odds Ratio-2.1,P= 0.018).
Conclusion:Majority of the HCPs had inadequate PA levels according to WHO guidelines. BMI ≥25 kg/m2 was associated with inadequate physical inactivity. The low level of PA implies that these HCPs are at risk for NCDs. This will have a negative impact on availability of human resource for health. There is an urgent need to establish programs to increase PA among HCPs.
Keywords: Body mass index, health care professionals, International Physical Activity Questionnaire, Nigeria, physical activity
How to cite this article:
Iwuala S O, Sekoni A O, Olamoyegun M A, Akanbi M A, Sabir A A, Ayankogbe O O. Self-reported physical activity among health care professionals in South-West Nigeria. Niger J Clin Pract 2015;18:790-5 |
How to cite this URL:
Iwuala S O, Sekoni A O, Olamoyegun M A, Akanbi M A, Sabir A A, Ayankogbe O O. Self-reported physical activity among health care professionals in South-West Nigeria. Niger J Clin Pract [serial online] 2015 [cited 2023 Jan 29];18:790-5. Available from: https://www.njcponline.com/text.asp?2015/18/6/790/163275 |
| Introduction | |  |
The World Health Organization (WHO) recommends that all adults should engage in at least 150 min of moderate-intensity physical activity (PA) or its equivalent per week.[1] PA is linked with lower rates of all-cause mortality,[2] and reduced risk for developing chronic diseases such as hypertension, diabetes, stroke, osteoporosis, cancer, and depression.[3] However, despite the benefits of PA, there is evidence that its levels are declining.[4] Data on PA levels from a WHO study of PA in 22 countries in Africa show a wide variation ranging from 46.8% in Mali in West Africa to 96.0% in Mozambique South-Eastern Africa but with no clear reasons for the variation.[5] Two countries in Southeast Africa, Malawi and Mozambique had the highest PA levels (95%), while Mali and Mauritania, two countries located in West Africa had the lowest levels (50%).[5]
In 2009, 17% of the world's population were reported to be physically inactive[6] and by 2012, 31% were physically inactive.[7] Physical inactivity has been identified as the fourth leading risk factor for global mortality, causing an estimated 3.2 million deaths worldwide.[1] Physical inactivity has also been linked to the epidemiologic transition from communicable diseases to chronic noncommunicable diseases (NCDs) in the African continent.[1] Studies on PA levels among Nigerian populations are limited; however, the result of a 2008 systematic review put the prevalence of physical inactivity at 25–57% among Nigerians.[8] A cross-sectional study conducted among an urban Northern Nigerian population found 68.6% to be sufficiently active.[9]
Health care professionals are a respected source of health-related information and are often perceived as role models of healthy lifestyle. However, a barrier to PA counseling by health care professionals is their personal PA habits, with physically inactive persons less likely to provide such information.[10],[11]
Several authors have reported PA levels among various categories of health care professionals such as doctors.[12][13][14][15][16] physical therapists[17] and medical students[11],[18] in developed countries. Some studies report higher PA levels among these groups compared with the general population,[14],[16],[17],[19],[20] suggesting that health care providers (HCPs) are good role models of PA. Other reports suggest that HCPs may not be good role models[12],[13] or showed that HCPs were less active than the general population.[21] Among HCPs in Africa, studies have mostly focused on exercise,[22],[23] which is a subcategory of PA or used other methods[24] apart from the International PA Questionnaire (IPAQ) in accessing PA. Thus, there is limited data on PA levels among HCPs in Nigeria and sub-Saharan Africa, where the burden of NCDs related to PA activity are on the increase, and the need to engage HCPs to combat the trend of physical inactivity in the populace.
We sought to determine the adequacy of PA among HCPs in a tertiary health facility in Nigeria. We also explored the predictors of PA among the HCPs.
| Methods | | |
This cross-sectional study was carried out among different cadres of HCPs of the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria between July and August 2013. LUTH is a 761 bed hospital and the largest of 5 tertiary health care facilities in Lagos State, South-West Nigeria. Lagos State is the commercial nerve center of Nigeria. The facility offers various services such as research, teaching, consultation and clinical services and has a total population of 1629 HCPs, comprised of 712 medical doctors and dentists, 705 nurses, 59 pharmacists, 8 pharmacy technicians, 38 laboratory scientists, 12 physiotherapists, 12 radiographers, 7 social workers, 3 optometrists and 5 dieticians.
Using a prevalence of 25% for physical inactivity among Nigerians,[8] at 95% confidence interval (CI), sample size of 245 was obtained using the Kish and Leslie formula,[25] and appropriate adjustment for a population < 10,000.[26] We, however, recruited 300 HCPs.
Multistage sampling was used to select the 300 HCPs in the hospital. Thefirst stage was the stratification of HCPs into their professions. Then proportionate sampling was used to determine the number of HCPs to be selected from each professional category. Respondents from the professional categories were randomly recruited until the desired sample size for that category was achieved. The HCPs who were acutely ill or pregnant were excluded from the study.
Ethical approval for the study was obtained from the Health Research and Ethics Committee of the hospital. Written informed consent was obtained from the study participants. Participation in the study was voluntary.
Data collection
A self-administered questionnaire was used to collect information on the socio-demographic characteristics of the HCPs while at their places of work (clinics, wards, laboratories, offices). The International PA Questionnaire-short form (IPAQ-SF) was used to determine PA levels. The IPAQ-SF consists of 7 items, estimates the time spent being physically active in the last 7 days, and measures vigorous-intensity activities, moderate-intensity activities (not including walking), walking and time spent sitting. These activity categories were multiplied by their estimated intensity in metabolic equivalents (METs) and summed to gain an overall estimate of PA in a week (www.ipaq.ki.se). One MET represents the energy expended while sitting quietly at rest and is equivalent to 3.5 ml/kg/min of volume of oxygen (VO2). The MET intensities used to score IPAQ in this study were vigorous (8 METs), moderate (4 METs), and walking (3.3 METs).
Anthropometric measurements (height and weight) were also obtained. Height was measured with a portable stadiometer in meters, with the HCP standing erect and the head in the horizontal plane, to within 0.01 m. Weight was measured without shoes, using an electronic scale, the Omron body composition monitor with scale (HBF-500). Privacy of the participants was ensured during the data collection process. Participants were also free to opt out of the study at any stage. The body mass index (BMI) was calculated as weight (kg)/height (m)2. The principal investigator and three trained research assistants, who had a minimum of tertiary level education, collected the data.
Data analysis
Physical activity levels were classified as low, moderate, or high intensity according to the IPAQ processing guidelines.[27] Low PA-no activity or some activity reported, but not enough to satisfy the requirements of the other activity categories; Moderate PA – any of the following three criteria: (a) 3 or more days of vigorous-intensity activity for at least 20 min/day, (b) 5 or more days of moderate-intensity activity or waking for at least 30 min/day, or (c) 5 or more days of any combination of walking, moderate-intensity, or vigorous-intensity activities achieving a minimum of 600 MET-min per week; High PA – either of the following two criteria: (a) 3 or more days of vigorous-intensity activity accumulating at least 1500 MET-min per week or (b) 7 days of any combination of walking or moderate- or vigorous-intensity activities achieving a minimum of 3000 MET-min per week.
These three groups were then categorized as adequate or inadequate PA. The adequate PA group included participants in the moderate- or high-intensity categories who met the WHO PA recommendation.[28] BMI was categorized according to the WHO weight criteria.[29] Overweight persons had a BMI 25–29.9 kg/m2 and obese persons ≥30 kg/m2.
The medical doctors and dentists were grouped together as doctors. Other health service providers apart from the nurses were merged and referred to as "others."
Microsoft Excel was used for cleaning the data while statistical analysis was done using the statistical package for social sciences, SPSS version 20.0 (IBM SPSS Inc. Chicago Illinois, USA). Continuous variables were expressed as means and standard deviation or median and interquartile range (IQR). Categorical variables were expressed as frequencies with accompanying percentages. Differences between groups were compared using the Chi-square and Fisher's exact test for categorical variables. Odds ratio and the corresponding 95% CI were presented. Multivariate logistic regression was used to determine the predictors of PA. The factors that had aP< 0.10 on bivariate analysis were put into a model to adjust for confounding factors. Statistical significance was set atP< 0.05.
| Results | | |
There were 300 HCPs studied, made up of 131 doctors, 12 dentists, 130 nurses, 12 pharmacists, 2 physiotherapists, 7 laboratory scientists, 1 optometrist, 1 dietician, 1 pharmacy technician, 1 radiographer and 1 social worker. Analysis was based on 298 HCPs as 2 HCPs responses were voided according to IPAQ guidelines.
The basic characteristics of the HCPs are shown in [Table 1]. The mean age of the HCPs was 39.2 (9.0) years, 185 (62.1%) were below 40 years of age; 197 (66.1%) were female, 152 (51.0%) had >10 years working experience, 133 (44.6%) were overweight, and 81 (27.2%) were obese.
| Physical activity of the health care providers | | |
[Table 2] shows the PA levels of the HCPs. A low level of PA was typical for the HCPs (79.2%). The frequencies of moderate and high levels of PA were 29 (9.7%) and 33 (11.1%) respectively. Therefore, only 62 (20.8%) of the HCPs had adequate PA level i.e., met the recommended levels of PA.
The median (IQR) total MET weekly energy expenditure of the HCPs was 533.25 (255.75–1653.00) MET-min week-1. There was a significant difference in the median MET-min week-1 between the low, moderate or high PA levels (P < 0.0001).
Walking was the most common form of PA undertaken by the HCPs. Majority (84%) of the HCPs had walked for at least 10 min at a time in the previous week. Only 24.7% and 35.3% respectively of the HCPs had participated in vigorous or moderate PA for at least 10 min in the previous week.
[Table 3] and [Table 4] show the bivariate and multivariate analyses of the association of PA level with the socio-demographic characteristics and BMI ≥25 kg/m2 among the HCPs. The factors that had aP< 0.10 were age group (P = 0.056), marital status (P = 0.062), ethnic group (P = 0.045), and BMI category ≥25 kg/m2 (P = 0.007). | Table 3: Association of physical activity level with sociodemographic characteristics and BMI
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 | Table 4: Multivariate analysis of the factors associated with physical activity among the HCPs
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After adjusting for confounding variables, persons with a BMI of ≥25 kg/m2 were twice more likely to have inadequate PA compared to those whose BMI was < 25 kg/m2 (P = 0.018).
| Discussion | | |
To the best of our knowledge, this is one of the few studies that investigated PA using a standardized PA questionnaire among different cadres of HCPs in a tertiary institution in Nigeria. In this study, 20.8% HCPs met the recommended levels of PA, with the majority (79.2%) being physically inactive. Likewise, in a study on the lifestyle of doctors in Enugu, Nigeria, only 38.1% met the recommended PA level.[23]
The prevalence of physical inactivity among HCPs in this study was higher compared to studies on PA among Nigerian populations. Among rural dwellers of a community in South-West Nigeria, only 29.8% were physically inactive,[30] despite the older age (mean of 67 years) of the rural dwellers. Among urban dwellers of Maiduguri, a city in Northern Nigeria, only 31.4% were physically inactive.[9] These findings suggest that HCPs in Nigeria have lower levels of PA compared to the general population. Potential factors contributing to low levels of PA among HCPs compared to the general population include long working hours and sedentary nature of their work.
On the contrary, studies from other parts of the world suggest that HCPs have higher PA levels compared with the general population. Estonian family physicians,[15],[19] Irish general practitioners,[14] US physicians and medical students,[18] US physical therapists, physical therapist assistants, and student physical therapists,[17] were all found to have higher PA levels compared with the general population.
In our study, physically inactive HCPs were 2 times more likely to be overweight compared to those who were physically active. Similar finding of the association between BMI category in the overweight or obese range and PA has been reported. Among medical personnel in Poland, physically inactive males were twice more likely to be overweight compared to those who were active.[31] In the study among doctors in Pakistan[32] and health workers of the Jos University Teaching Hospital, Nigeria,[33] physical inactivity was associated with BMI in the overweight and obese categories respectively.
We did not find an association between health professional group and PA [Table 3]. A study carried out in Croatia found nurses and physicians to be equally physically inactive.[34] On the other hand, among Polish medical personnel, doctors compared with nurses and other nonnursing professional categories were more likely to be physically inactive.[31]
| Conclusion | | |
The high rate of physical inactivity and overweight/obesity among this group of HCP in Nigeria puts them at risk of NCDs. This has public health implications. If the health workforce in Nigeria, which is still inadequate in numbers is unhealthy, this will limit the capacity to provide health related services to the people. The effectiveness of Nigerian HCPs as good role models, health promoters and health educators of PA is also in question. In this study, physical inactivity was associated with a BMI ≥25 mg/m2. The high burden of overweight/obesity and physical inactivity among Nigerian HCPs is a thrust for further research. Furthermore, this call for an urgent need health promotion programs that will increase PA.
Limitations of the study
Due to the cross-sectional nature of our study, it was impossible to establish causality between PA and weight status.
Self-report of PA could lead to underestimation or overestimation of PA levels. We hope that the use of a standardized questionnaire that has been validated for use in Nigeria for assessment of PA will limit that.
In spite of these limitations, the study gives a useful glimpse of PA among HCPs who are meant to be role models of good health and behavior as well as health educators to the populace.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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