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Physical Activity in Students of the Medical University of Silesia in Poland

Magdalena Dąbrowska-Galas, Ryszard Plinta, Jolanta Dąbrowska, Violetta Skrzypulec-Plinta
DOI: 10.2522/ptj.20120065 Published 1 March 2013

Abstract

Background Medical students and other health care professionals have substantial knowledge of the benefits of regular physical activity. Furthermore, as they have an ethical obligation to prescribe suitable exercises, they can influence their patients' attitude toward physical activity and can become role models for their patients. Physical therapists, who are primary care practitioners, have great potential for promoting physical activity; however, their role is still underestimated by patients and health care professionals.

Objective The objectives of this study were to evaluate physical activity level in students of the Medical University of Silesia in Poland and to focus on the role of physical therapist students in promoting physical activity.

Design This was a cross-sectional study.

Methods The final analysis included 300 students from the schools of physical therapy, midwifery, nursing, pharmacy, cosmetology, and medicine at the Medical University of Silesia. The short form of the International Physical Activity Questionnaire (IPAQ) was used to evaluate physical activity level.

Results Physical therapist students demonstrated the highest level of physical activity, with 46% demonstrating a high level of physical activity, 54% a moderate level of physical activity, and none a low level of physical activity. The largest group of students with a low level of physical activity comprised students from the school of medicine (26%).

Limitations The number of respondents was relatively small. The main study limitations included its cross-sectional nature and the possibility of self-report biases. Further research is warranted to expand the study nationally and determine which factors influence physical activity.

Conclusions There was a large group of medical students who, despite being aware of benefits of physical activity, did not meet the recommended level of physical activity. Physical therapist students are well trained and qualified to promote healthy habits and encourage individuals to undertake regular physical activity.

Physical inactivity and the associated health problems pose a current and growing threat to public health.1 The World Health Organization (WHO) reports that approximately 60% of the global population do not meet the recommended daily minimum of physical activity.2

Caspersen et al defined physical activity as “the bodily movement produced by skeletal muscles that results in energy expenditure.”3(p126) Much has been written about regular physical activity as an important factor contributing to a healthy lifestyle, strength, muscular endurance, speed, and flexibility.4–7 Furthermore, physical activity reduces the risk of diabetes mellitus and osteoporosis, although a lack of physical activity in the adolescent years may lead to health problems later in life.8,9

Until recently, only vigorous physical activity was promoted as beneficial to health. Participation in activities of moderate intensity, however, also brings numerous health benefits such as lower cardiovascular mortality and enhanced quality of life. Furthermore, moderate physical activity appears to reduce the risks of Alzheimer disease, obesity, and osteoporosis.10–14 The American Heart Association together with WHO and the American College of Sport Medicine (ACSM) unanimously recommend 30 minutes of moderate-intensity physical activity 5 days per week or 20 minutes of vigorous-intensity physical activity 3 days per week for all adults.15 The WHO highlights that every activity that lasts more than 10 minutes is beneficial.16 It is crucial for children to develop healthy habits, as a high physical activity level in childhood and the adolescent years increases the probability of a higher physical activity level in the future.11–16

Several authors17–20 have observed a positive relationship between physical fitness and students' academic results. It is presumed that medical students have substantial knowledge about physical activity and its benefits, and as health care professionals they will have an influence on their patients' attitude toward physical activity and an ethical obligation to prescribe suitable exercises.21–24 Numerous studies on physical activity level have produced different results, often presenting a sharp contrast between medical students' knowledge about the benefits of regular physical activity and its application in everyday life.25–30 Ángyán et al30 reported that medical students had low physical activity levels as a result of high workload and less free time. However, Frank et al31 reported that American medical students demonstrated higher physical activity levels compared with their peers and that more than half (61%) of them followed the Centers for Disease Control and Prevention's recommendations for physical activity.

Physical therapists, who are primary care practitioners, have a great potential for promoting physical activity. They prescribe suitable exercises for a wide range of conditions, and they should be committed to promoting physical activity and exercise.1,32,33 Chevan et al34 have shown that physical therapists, physical therapist assistants, and physical therapist students all followed the ACSM recommendations for physical activity, and their physical activity level was higher compared with that of the general public and other health care professionals. Physical therapist students were found to have a high level of physical activity as a result of their university modules involving sports as well as their free-time activities such as volleyball, basketball, swimming, or cycling.35 However, Gorner et al36 compared the physical activity levels of physical therapist students and physical education students from the same university and observed that the physical therapist students had different sports classes and, therefore, lower physical activity levels. Physical therapist students' opinions regarding their role in promoting physical activity remain unknown. Also, their physical activity level varies depending on the sports classes taken as part of their course. Thus, physical activity level in physical therapist students needs to be explored further by comparing it with that of students with the same sports classes.

The objectives of this study were to evaluate physical activity level in students of the Medical University of Silesia in Poland and to focus on the role of physical therapist students in promoting physical activity.

Materials and Method

The study was conducted in 2009. A random group of 60 students from each of the schools of physical therapy, medicine, nursing, midwifery, cosmetology, and pharmacy was selected. Students participated in the study solely at their own discretion, having given their verbal consent following an explanation of the research outline. Each respondent received such explanation individually. The inclusion criterion was granting consent to participate in the study. The exclusion criteria were contraindications for physical activity and lack of approval for participation in the research.

The anonymous questionnaire used in this study was composed of 2 parts. The first part was the recommended short version of the standardized and validated International Physical Activity Questionnaire (IPAQ), widely used for assessing physical activity levels worldwide. In 2000, 14 centers from 12 countries collected reliability and validity data on at least 2 of the 8 IPAQ instruments. Test-retest repeatability (intraclass correlation coefficients=.70–.80) was assessed within the same week. Concurrent (inter-method, median rho=.67) validity (with criterion validity around rho= 0) was assessed at the same administration, and criterion IPAQ validity was assessed using the MTI/CSA ActiGraph accelerometer (Actigraph, Pensacola, Florida). Spearman correlation coefficients were reported based on the total reported physical activity. The IPAQ has been used for physical activity overview in various countries and in the European Union.37–39 The minimum time of 10 minutes of physical activity was required to include it in the analysis. The short version relates to the physical activities performed at a high or moderate level, walking, and time spent sitting. The level of physical activity referred to in the questionnaire is presented in the corresponding metabolic equivalent (1 MET=a resting energy expenditure assuming oxygen consumption of 3.5 mL-min/kg weight). According to the requirements of the questionnaire, the following average value of the intensity of physical activity was used in the analysis of the IPAQ data: walking=3.3 METs, moderate physical activity=4.0 METs, and vigorous physical activity=8.0 METs. Total physical activity level was defined in MET-minutes/week in each school of the university.

Students were assigned to 3 different categories of physical activity level (low, moderate, and high), assessed using the following formula: MET level × minutes of activity/day × days per week.40 The reported values for physical activity were based on the participants' self-report on the questionnaire and were not directly measured by the researchers. Body mass index was calculated from self-reports of height and weight.

The second part of the questionnaire included questions concerning personal information, such as body weight, height, and school of the university. This section also included questions about self-assessment of physical activity, membership in the Academic Sports Association of the Medical University of Silesia, and students' opinions regarding the need for physical activity.

Data Analysis

Descriptive statistics are presented as mean, 95% confidence interval, median, minimum and maximum values, standard deviation, and coefficient of variability (CV). Table 1 presents data on students' answers to questions regarding nominal variables. Total physical activity level was assessed as proposed by the IPAQ scoring protocol; this variable was presented for each school separately, and the Kruskal-Wallis test was used to compare physical activity levels among all schools. The significance between the level of physical activity and the nominal variables (answers to the yes/no questions) was assessed using the Mann-Whitney U test. Data were analyzed using Statistica 8.0 software (StatSoft Inc, Tulsa, Oklahoma), and values were considered statistically significant at P<.05.

View this table:
Table 1.

Students' Answers to the Following Questions From the Questionnairea

Results

Data for 300 completed questionnaires out of the 360 mailed questionnaires were included in the final analysis. All of the respondents were white. The group comprised 79% (n=236) female students and 21% (n=64) male students. All respondents from the schools of nursing, midwifery, and cosmetology were female (n=44, n=51, n=53, respectively), whereas the respondents from the school of physical therapy were 34 female and 21 male students, those from the school of medicine were 14 female and 31 male students, and those from the school of pharmacy were 40 female and 12 male students (data not shown).

Physical therapist students were aged 20.54±1.74 (mean ± SD) years, cosmetology students 20.52±1.33 years, midwifery students 19.76±0.87 years, nursing students 20.76±1.35 years, pharmacy students 20.88±0.90 years, and medical students 23.18±1.02 years. The highest mean BMI was observed among the medical students (23.75 kg/m2), and the lowest BMI was observed among the students of cosmetology (20.37 kg/m2) (Tab. 2).

View this table:
Table 2.

Descriptive Statistics of Students of the Medical University of Silesia (n=300)a

The MET level was multiplied by minutes of physical activity and by events per week, and the result was expressed as MET-min/week. In accordance with the IPAQ scoring protocol, students were assigned to 1 of 3 categories representing low, moderate, and high levels of physical activity. Respondents assigned to the group with a high level of physical activity had to meet one of the following criteria: (1) participate in vigorous-intensity activity a minimum of 3 days per week, accumulating not less than 1,500 MET-min/week, or (2) 7 or more days of any combination of walking, moderate-intensity activity, or vigorous-intensity activity, achieving a minimum of 3,000 MET-min/week. Respondents assigned to the group with a moderate level of physical activity had to meet one of the following criteria: (1) 3 or more days of vigorous activity for at least 20 minutes per day, (2) 5 or more days of moderate-intensity activity or walking for at least 30 minutes per day, or (3) 5 or more days of any combination of walking, moderate-intensity activity, or vigorous-intensity activity, achieving a minimum of at least 600 MET-min/week. Individuals who did not meet the criteria for moderate or high physical activity level were considered low/inactive.40

Among the physical therapist students, none had a low level of physical activity, 54% demonstrated a moderate level of physical activity, and 46% demonstrated a high level of physical activity. Furthermore, a high level of physical activity was observed in 28% of the cosmetology students, 22% of the midwifery students, 22% of the medicine students, 8% of the nursing students, and 10% of the pharmacy students.

The majority of students were classified as having a moderate level of physical activity (school of cosmetology=58%, school of midwifery=66%, school of nursing=86%, school of pharmacy=86%, and school of medicine=52%). The largest number of students with a moderate level of physical activity was observed in the schools of nursing and pharmacy (86%). On the other hand, the largest group of students with a low level of physical activity was observed in the school of medicine (26%), compared with 14% in the school of cosmetology, 12% in the school of midwifery, 6% in the school of nursing, and 4% in the school of pharmacy (Figure).

Figure.
Figure.

Percentage distribution of physical activity levels among the students (P<.05).

The respondents also were asked about their attitude toward physical activity and about membership in the Academic Sports Association. Fifty-eight percent of the medical students perceived themselves as physically active, whereas 62% claimed to have been physically active before they started studying, compared with 38% of the physical therapist students (98% before they started studying), 42% of the cosmetology students (74% before they started studying), 48% of the midwifery students (86% before they started studying), 50% of the nursing students (82% before they started studying), and 22% of the pharmacy students (82% before they started studying).

Only 14% of the medical students, 10% of the cosmetology students, 4% of the nursing and pharmacy students, and 2% of the midwifery students were members of the Academic Sports Association. The majority of students did not use the university sports facilities (100% of the physical therapist students, 84% of the cosmetology students, 98% of the midwifery students, 98% of the nursing students, 78% of the pharmacy students, and 68% of the medical students). Most students claimed that physical activity is an important part of their daily life (100% of the physical therapist and nursing students, 96% of the cosmetology students, 90% of the midwifery and pharmacy students, and 82% of the medical students).

Only a small number of all students claimed not to feel the need for regular physical activity (2% of the physical therapist students, 6% of the cosmetology students, 10% of the pharmacy students, 12% of the midwifery students, 16% of the nursing students, and 32% of the medical students) (Tab. 1).

The Mann-Whitney U test indicated a significant relationship (P<.05) between the level of physical activity and factors such as physical fitness currently and before studying at the university, views on the importance of physical activity in everyday life, and the need for regular physical activity (Tab. 3).

View this table:
Table 3.

Physical Activity Level Compared With Different Predictors, Mann-Whitney U Test

Discussion

Regular exercise is an essential part of a healthy lifestyle; therefore, all medical professionals should maintain the recommended physical activity level in order to remain healthy and look credible in the eyes of their patients.41–44

The objectives of this research were to evaluate physical activity level among students of the Medical University of Silesia in Poland and to focus on the role of physical therapist students in promoting physical activity. It is assumed that medical staff should be physically active to be credible while promoting exercise among their patients and that physical therapists are well prepared and qualified to promote physical activity, although their role often is underestimated by other health care professionals.1,45–48

It is well known that there is a direct correlation between physical activity level in medical students and medical advice they give to patients.49–51 The level of physical activity among students as a predictor of health promotion was evaluated based on a review of the literature.21,52,53 Various studies produced different results, which were claimed to have followed from the differences in sports modules at universities. In our research, all physical therapist, medicine, nursing, midwifery, cosmetology, and pharmacy students attended the same university and had the same compulsory physical education program. The IPAQ scores showed that 26% of the medical students demonstrated a low level of physical activity, and the average physical activity level was the lowest compared with other students. Fifty-eight percent of the medical students considered themselves physically active, although the physical activity level in this group turned out to be the lowest. It was found that the majority of students undertake physical activity only as part of their physical education module, which means that future physicians may not apply their substantial knowledge of the benefits of physical activity in their everyday lives. Therefore, our results are consistent with the findings of other researchers who have reported that medical students do not meet the recommended level of physical activity.25,54 However, these results are in contrast to those of other researchers who reported that medical students had a higher level of physical activity than their peers.22,24,31

Physical therapist students demonstrated the highest level of physical activity compared with students of other schools. Forty-six percent were assigned to the high level of physical activity category, 54% to the moderate level of physical activity category, and none to the low physical activity level category. Several years previously the university admission examination for future physical therapist students comprised a written test and a sports test. Therefore, it was not surprising that these students demonstrated the highest physical activity level. Although a sports test is no longer part of the admission test, the physical activity level of physical therapist students remains the highest in comparison with that of students of other schools. This high level of physical activity may result from greater awareness of the need for regular physical activity because during their internships at hospitals and sport centers, they prescribe suitable exercises to their patients. Also, physical therapist students were found to participate in more sports in their free time.

Ninety-eight percent of the physical therapist students claimed that they were physically active before starting university, and 62% did not perceive themselves as physically active now, even though their level of physical activity turned out to be the highest. Our analysis showed a statistically significant difference between students' perception of their current physical activity level and their actual level of physical activity (P<.005), between their physical activity level before the start of university and their current physical activity level (P<.05), and between their current level of physical activity and their opinion regarding its need and importance (P<.05). The difference between physical activity level in medical students and physical activity level in physical therapist students, as well as their different perceptions of their own physical fitness, suggests that the need for physical exercise among these students varies.

The results of this study demonstrated that physical therapist students participated in sports not only as part of their university modules, but also in their free time. They also indicated that nearly all of the students recognized the importance of physical activity in their everyday lives, and approximately 90% of all students felt the need to exercise regularly. Not many students were members of the Academic Sports Association—only 2% of the midwifery students, 4% of the nursing and pharmacy students, 10% of the cosmetology students, and 14% of the medical students. There were no members of the Academic Sports Association among the physical therapist students. Furthermore, a limited number of university sports facilities means that the majority of students cannot participate in sports at their universities.

We agree with the assumption that previous habits affect future physical activity level and compulsory sport modules and better sports facilities would definitely contribute to improving students' physical activity level.24,25,30

Limitations

The main study limitations include its cross-sectional nature and the possibility of self-report biases; however, the study used the externally validated IPAQ, the most widely recommended tool for the assessment of physical activity level.40 Future research on physical activity level using the IPAQ would enable comparison with the results of other studies.

The number of respondents was relatively small. The study was limited to students attending one of the largest medical universities in Poland. Future research on students from various universities, not only Polish universities, would undoubtedly demonstrate correlation between the physical activity level of medical professionals and healthy habits of their patients. It also would show the role of physical therapists in promoting physical activity.

Conclusions

The level of physical activity among most students from the Medical University of Silesia in Poland was found satisfactory, although there was a group of students who, despite being aware of the benefits of physical activity, did not meet the recommended level of physical activity and did not apply their knowledge in everyday life. Physical therapist students demonstrated the highest level of physical activity compared with other students from the same university. They are well trained and qualified to promote healthy habits and encourage individuals to undertake regular physical activity. Therefore, all health care professionals should recognize physical therapists' potential for promoting a healthy lifestyle and physical activity, as well as follow their example and put their substantial knowledge of the benefits of physical activity into practice in order to gain credibility in their patients' eyes. Professional medical advice regarding physical activity may encourage patients to adopt and maintain new, healthy habits. Therefore, if students of medical schools improve their own habits, it may positively affect their attitude toward medical advice regarding physical activity. Regular physical activity contributes to good health, and healthy habits will help promote physical activity in future patients.

Footnotes

  • Ms Dąbrowska-Galas provided concept/idea/research design and study participants. Ms Dąbrowska-Galas and Dr Dąbrowska provided writing. Ms Dąbrowska-Galas and Dr Plinta provided data collection. Ms Dąbrowska-Galas and Dr Skrzypulec-Plinta provided data analysis. Dr Plinta, Dr Dąbrowska, and Dr Skrzypulec-Plinta provided project management and institutional liaisons. Dr Dąbrowska provided facilities/equipment. Dr Plinta and Dr Skrzypulec-Plinta provided consultation (including review of manuscript before submission).

  • The study was approved by the Institutional Review Board of the Medical University of Silesia.

  • Received February 18, 2012.
  • Accepted October 9, 2012.

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Physical Activity in Students of the Medical University of Silesia in Poland
Magdalena Dąbrowska-Galas, Ryszard Plinta, Jolanta Dąbrowska, Violetta Skrzypulec-Plinta
Physical Therapy Mar 2013, 93 (3) 384-392; DOI: 10.2522/ptj.20120065

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Physical Activity in Students of the Medical University of Silesia in Poland
Magdalena Dąbrowska-Galas, Ryszard Plinta, Jolanta Dąbrowska, Violetta Skrzypulec-Plinta
Physical Therapy Mar 2013, 93 (3) 384-392; DOI: 10.2522/ptj.20120065
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