|Year : 2020 | Volume
| Issue : 3 | Page : 137-143
Physical Activity Pattern Among Female College Students at Taibah University
Rola Adnan Jalloun1, Amal Mohammed Surrati2
1 Nutrition and Food Science Department, Taibah University, Madinah, 42353, Kingdom of Saudi Arabia
2 Family and Community Medicine Department, Taibah University, Madinah, 42353, Kingdom of Saudi Arabia
|Date of Submission||10-Feb-2020|
|Date of Decision||09-Mar-2020|
|Date of Acceptance||08-Apr-2020|
|Date of Web Publication||20-Aug-2020|
Rola Adnan Jalloun
Assistant Professor of Nutrition and Food Science Department, Taibah University, Madinah, 42353, Kingdom of Saudi Arabia
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Physical activity simply is any movement of the body that sustains and empowers physical fitness and overall health and wellness. Physical inactivity became a concern in the Kingdom of Saudi Arabia especially in females during the last few decades. The purpose of this study was to assess the physical activity patterns among female college students. Methods: A cross-sectional study was conducted among 658 female college students at Taibah University. The short form of the Arabic version of the International Physical Activity Questionnaire (IPAQ) was used to assess physical activity pattern. Additional data were collected on body mass index (BMI), body composition, including body fat percentage (BF%), visceral fat level (VFL), and skeletal muscle percent (SM%). Results: Overall, 37.5% of the students performed vigorous-intensity, and 44.9% performed moderate-intensity physical activity. Both BMI and BF% were significantly inversely associated with vigorous and moderate physical activity. These associations appeared to be stronger among students who performed vigorous physical activity for ≥75 min/week for BMI (aOR = 0.559, 95% CI 0.318–0.687) and BF% (aOR = 0.389, 95% CI 0.044–0.507) and moderate physical activity for ≥ 150 min/week for BMI (aOR = 0.580, 95% CI 0.205–0.812) and BF% (aOR = 0.320, 95% CI 0.124–0.402). Conclusion: Although both vigorous and moderate physical activity appeared to affect BMI and BF%, among college students who performed physical activity, our findings suggest the need for strategies to increase awareness among female students to be physically active to promote healthy lifestyles and substantial health benefits.
Keywords: Body composition, body fat percentage, body mass index, physical activity
|How to cite this article:|
Jalloun RA, Surrati AM. Physical Activity Pattern Among Female College Students at Taibah University. Int J Nutr Pharmacol Neurol Dis 2020;10:137-43
|How to cite this URL:|
Jalloun RA, Surrati AM. Physical Activity Pattern Among Female College Students at Taibah University. Int J Nutr Pharmacol Neurol Dis [serial online] 2020 [cited 2020 Oct 31];10:137-43. Available from: https://www.ijnpnd.com/text.asp?2020/10/3/137/292680
| Introduction|| |
Physical activity (PA) is any movement of the body that sustains and increases physical fitness and overall health and wellness. Physical inactivity has become a concern in the Kingdom of Saudi Arabia (KSA) in the last few decades, especially among females, and 58.5% of the Saudi adult population is considered physically inactive. In 2015, Al-Zalabani et al. and his colleague found that the prevalence of physical inactivity in KSA was 66.6% for the overall Saudi Arabian population, 60.1% for men and 72.9% for women; a nationwide study showed a very low prevalence of PA: 6.1% for men and 1.9% for women
Being physically active improves many aspects of individual health, including disease-prevention, mental and psychosocial aspects. The estimated increase in life expectancy as a result of eliminating physical inactivity is 1.51 years.. The risk of diabetes, stroke, ischemic heart diseases, and breast and colon cancers is reduced by PA, and PA decreases blood pressure and heart rate values; anxiety, depression, and stress are also reduced and mental health is improved as a result of PA. Clinicians advise obese people to be more physically active as a strategy for obesity management, and clinicians consider PA as an independent factor in the control and reduction in body weight, total body fat and visceral fat. In the PREMIER trial, patients with chronic diseases were counseled about the importance of lifestyle modification, and in these patients, PA was inversely related to body mass index (BMI), waist circumference, waist-to-height ratio and fat-mass percentage and positively related to fat-free mass percentage.
Strong evidence has been found supporting the effectiveness of counseling; PA is also a very effective method for reducing the risk of chronic illnesses, regardless of the degree of obesity, and a PA intervention resulted in a 12%–14% reduced risk of chronic illness over an 18-month period (based on the 10-year Framingham Coronary Heart Disease Risk Score),, even without reducing calorie intake. Research shows that university students tend to be less active as their autonomy increases throughout middle and high school, reflecting negatively on their overall health and placing these individuals at increased risk of obesity and cardiovascular diseases. It has been observed that weight gain and the higher prevalence of overweight and obesity among university students are increasingly common and a source of concern for the health system. For instance, if body weight increases, the risk of cardiovascular diseases, heart failure, arterial hypertension, myocardial infarction, cerebral vascular accidents, joint disorders, some types of diabetes, and some types of cancer will increase. An increase in BMI in this specific population can be explained by the fact that most university students undergo lifestyle changes, such as leaving home, going to university, leaving a familiar environment, starting work, and having increased autonomy in decision-making. This transitional period between childhood and adulthood affects energy balance, leading to weight gain.
A way to control a substantial weight gain and the consequent advancement of obesity is through PA. Psychological distress is also one of the potential factors related to body composition (BC). Being in the underweight or obese categories increasing the odds of experiencing medium to high psychological distress in the general population. By definition, less than 150 min of moderate PA per week is considered insufficient, and this lack of PA is the main contributor to health risk globally. Moreover, 40.0–50.0% of young adults do not meet the recommendations of at least 150 min of moderate-to-vigorous PA weekly, and only 9.0% of young adults meet the criterion of completing 10,000 steps every day. It has been reported that the barrier for achieving an adequate PA level is a lack of time for counseling, health personnel’s limited knowledge/awareness of the benefits of PA, limited material resources in health centers, lack of specialty clinics at the primary healthcare (PHC) level, and limited availability of human resources. A cohort study conducted in the United Kingdom found that brief PA counseling in the context of primary care was a cost-effective way to promote and improve PA among adults. Additionally, the American Heart Association has emphasized that “the advice from health care professionals significantly influences the adoption of healthy lifestyle behaviors, including regular PA, and can increase satisfaction with medical care”. BC is an evaluation method that measures the major structural components of the body: muscle, body fat and visceral fat. Usually, BC assessment is used to monitor performance and training in the athletic community and to assess the health status of the population in general. BC is an important indicator of the physical fitness and general health of athletes, and today, it is often discussed in the scientific literature., The objective of this study was to assess PA pattern in a sample of female university students at Taibah University in 2019.
| Materials and Methods|| |
Design and sample
A cross-sectional study was conducted through random sampling method at the Madinah main branch of Taibah University, KSA, during the spring of 2019. A total of 662 female students aged 18–24 years participated. Three pregnant students and one lactating student were excluded from the study. A written consent form was used, and the response rate among the students was 98.5%. The study was approved by the committee of research ethics at Taibah University.
Self-reported questionnaires and anthropometric measurements were used for data collection. The questionnaire contained two parts. The first part of the questionnaire contained information on demographic data and BC measurements. The short form of the Arabic version of the International Physical Activity Questionnaire (IPAQ) was used in the second part of the questionnaire. All participants were informed of the instructions before completing the questionnaire.
BC was determined by anthropometric measurements, which included height, weight, BMI, body fat percentage (BF%), visceral fat level (VFL), and skeletal muscle percentage (SM%). A bioelectrical impedance analysis (BIA) device (Omron Healthcare Co. Ltd., Kyoto, Japan (BF 501)) was used to obtain anthropometric measurements. All participants were informed to fast prior to the day of the measurements because body water fluctuations affect BC measurements. Details of the manufacturer’s instructions for using the device have been published previously and were followed in the study.
BMI is the ratio between weight in kilograms to height in meters squared. Based on the National Institutes of Health (NIH), BMI of the participants was classified as underweight (BMI ≤ 18.0), normal (BMI = 18.5–24.9), overweight (BMI = 25.0–29.9) or obese (BMI ≥ 30.0). Moreover, obese can be classified into three different categories: grade 1 (BMI = 30.34.9), grade 2 (BMI = 35.0-39.9) and grade 3 (BMI ≥ 40). Based on gender and age, BF% was measured, and the participants were classified as having a low (BF% < 21.0%), normal (BF% 21.0–32.9%), high (BF% 33.0–38.9%), or very high (BF% ≥ 39%) BF%. VFLs were categorized as normal (VFL = 1–9), high (VFL = 10–14) or very high (VFL = 15–30). Furthermore, SM% was measured and classified as low (SM% < 24.3%), normal (SM% = 24.3–30.3%), high (SM% = 30.4–35.3%) or very high (SM% ≥ 35.4%).
The Statistical Package for Social Sciences (SPSS Ins., Chicago, IL, USA) version 25 was used for data analysis. Means and standard deviations were used to express quantitative variables. Frequencies and percentages were used to describe qualitative variables. Pearson’s chi-square test was applied to test for statistical significance; P < 0.05 was considered statistically significant. Logistic regression analyses were used to evaluate the effect of PA intensity on each BC measurement, with weight as the reference category.
| Results|| |
A total of 658 female students, with an average age of 21 ± 1.3 years, were recruited from Taibah University. The mean weight and height of the student were 56.8 ±14.3 kg and 155 ±7.7 cm, respectively. The average BMI, BF%, VFL and SM% were 23.6± 8.3, 35.1 ± 12.4%, 4.0 ± 1.7 and 23.9 ± 4.1%, respectively [Table 1].
Based on the IPAQ scoring system, 44.9% of all students were physically active, and among them only 37.5% and 44.9% of the active students had vigorous and moderate-intensity PA levels, respectively. Vigorous-intensity PA and moderate-intensity PA were reported in 37.5% and 44.3% of the students, respectively, and the vast majority of these students had a normal BMI. Although a high and very high BF% was reported in 58.3% among participants, these percentage appeared higher among nonphysical active group. Both vigorous and moderate PA participants had a normal VFL 99.5%. Regarding SM%, 58.5% had low level and it appeared to be stronger among students who didn’t perform vigorous or moderate physical activity by 61.8% and 52.8%, respectively. The associations among the BC components were significant (<0.001), including the associations between BMI, BF% and vigorous-intensity activities and between BMI and moderate-intensity activities [Table 2].
|Table 2 Association between the BC components (BMI, BF%, VFL, SM%) of female Taibah students and their PA behaviors|
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According to the WHO criteria for adults aged 18–64, the students should perform at least 150 min of moderate-intensity aerobic PA throughout the week or perform at least 75 min of vigorous-intensity aerobic PA throughout the week. We stratified the data by time to examine whether the associations between the BC components and PA differed in the active participants.
Logistic regression analysis was performed on all BC components separately for a variety of intensities of PA [Table 3] and [Table 4]. Among students who performed vigorous activity, there were significant decreases (adjusted odds ratio [aOR] for 10 ≥ min/week vs. 75 ≥ min /week) in weight (0.675 [0.870–1.093]), BMI (0. 559 [95% CI 0.318–0.687]), and BF% (aOR = 0.389 [95% CI 0.044–0.507]) and an increase in SM% (aOR = 1.558 [95% CI 1.574–3.253]) based on the duration of the activity, while moderate activities were associated with decreased BMI (aOR = 0.580 [95% CI [0.205–0.812]) and BF% (aOR ≥ 10 min/week vs ≥ 150 min/week = 0.320 [95% CI [0.124–0.402]).
|Table 3 Logistic regression analysis for BCs (BMI, BF%, VFL and SM%) associated with vigorous-intensity activities among active participants|
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|Table 4 Logistic regression analysis the association of BC components (BMI, BF%, VFL and SM%) with moderate-intensity activities among active participants|
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| Discussion|| |
The purpose of this study was to assess PA pattern among female students at Taibah University in KSA. The demographic data showed that our participants were mostly unmarried, healthy females and living in Madinah. The current data demonstrated that a slightly larger proportion of subjects were classified into the normal category of BMI and a smaller proportion was classified into the combined underweight, overweight and obese group. The mean BMI was 21.5 ± 1.8, which is consistent with the results of similar target populations in Saudi Arabia and in different countries.,,,,, A relevant finding was that our study was not the first to reveal a prevalence of normal weight according to BMI classification conflicting with high levels of body fat (according to %BF). Additionally, 53.9% of the sample of 355 university students were of normal weight according to BMI, and more than 55% had high or very high levels of total body fat. The present work also showed that the total BF% exceeded its normal value in more than half of the subjects. Compared with similar studies, our results also revealed that normal, overweight, and obese female college students have a greater BF% than Lebanese, Korean and American female college students., Most of the students in our study had a normal VFL, which is in agreement with the findings of other studies in the KSA. Regarding SM%, the findings here indicate that the mean SM% of the students (23.9 ± 4.1%) was very low and was strikingly different from results from studies in Western countries.,
The current data demonstrate that more than half of the female students were physically inactive. Physical inactivity is a term that is used to describe people who do not meet the recommended level of regular PA for many reasons. According to the World Health Organization, 58.5% of adults, 71% of youth, and 57% of children are considered physically inactive. There is significant evidence documenting the decline in activity levels through adolescence, and this trend continues with increasing age throughout adulthood. A study of 233 undergraduate students reported that PA levels decreased during the transition from high school to college years; 65% of students reported engaging in regular vigorous PA and 26% reported engaging in regular moderate PA during high school. However, upon follow-up, during their college years, 38% of students participated in regular vigorous PA and 20% participated in moderate PA. The 2013 Survey of Health Information in KSA estimated that 60% of the entire Saudi population was physically inactive. Furthermore, 58% of 1257 healthy college students at King Khalid University (426 males and 831 females) were found to be physically inactive. Arab Gulf countries also showed a high prevalence of physical inactivity. For instance, two studies conducted in the United Arab Emirates, Kuwait, and Iraq reported a prevalence of physical inactivity among female student colleges of 62%, 64% and 47%, respectively.,, Similar studies have been conducted in other countries: in Romania, 34.745% of female university students were sedentary and 34.474% did not perform enough PA; in China and Brazil, one-third of students were found to be inactive. The rate of physical inactivity decreased to 11.3% among Egyptian female students. Despite the differences in the sample size of the previous studies, their findings still reflect the high prevalence of being physically inactive among young females across different nations.
The link between BC and PA has been observed in some earlier studies. Our data support the inverse relationship between PA and BMI and BF% observed in different populations resulting from the different PA intensities.,, Previous research suggests that people who had a sedentary lifestyle had more body fat and less lean mass than those who regularly engaged in aerobic-type exercise.,, Although it is common to expect weight loss in response to exercise, our study showed a significant decrease in weight for women who participated in exercise. Regardless, it is critical to emphasize that in the present study, students who performed vigorous-intensity activities for more than 75 min/week had a lower BMI and BF% than students who performed PA for shorter time or moderate-intensity PA.
Moreover, several studies have reported that the BC differences that are related to differences in PA level are based on other factors.,,, For instance, age and gender differences are main factors that play an important role in this relationship.,, However, many experiments clearly illustrated that increasing age above 50 years is associated with elevated fat mass, decreased fat-free mass, and decreased PA. In young adults, long-term PA lowers fat mass and increases fat-free mass. Gender also plays an important role in PA and BC components.,, It has been reported that performing PA leads females to lose fat more than males because females have more fat than males.,, Unfortunately, in our study, we could not test these factors because we focused on only females, and there was no significant difference in the age of our students. Therefore, further research should consider the potential effects of gender and age more carefully on this relationship.
| Conclusion|| |
In short, our findings showed low rates of PA among female college students at Taibah University in KSA. Furthermore, the majority of the students performed moderate-intensity activity for more than 10 min/week. The results of the present study confirmed that moderate PA was associated with decreased BMI and BF%, while vigorous activity was associated with lower BMI and BF% and a high level of SM%. These associations were strong when the duration of the activity was long. Our findings recommended the need to increase awareness of the importance of PA, to write down strategies and coordinate efforts at all levels (family, university, community and government) to support our females in becoming more physically active to promote a healthy lifestyle. Due to the differences in BC that occur with age, our results are subject to replication among old, middle-aged and high school females.
Author disclosure statement
Both authors conceived and designed the study, performed the experiments, analyzed the data and wrote the paper. All authors read and approved the final manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
WHO. Country Cooperation Strategy for WHO and Saudi Arabia 2012–2016. World Health Organization Regional Office for the Eastern Mediterranean Cairo (2013). doi:10.1002/ajmg.c
Al-Zalabani AH, Al-Hamdan NA, Saeed AA. The prevalence of physical activity and its socioeconomic correlates in Kingdom of Saudi Arabia: a cross-sectional population-based national survey. J Taibah Univ Med Sci 2015. doi:10.1016/j.jtumed.2014.11.001
Mabry R, Koohsari MJ, Bull F, Owen N. A systematic review of physical activity and sedentary behaviour research in the oil-producing countries of the Arabian Peninsula. BMC Public Health 2016. doi:10.1186/s12889-016-3642-4
Lee I-M et al.
Impact of physical inactivity on the world’s major non-communicable diseases for the Lancet Physical Activity Series Working Group, Lancet Physical Activity Series working group. Lancet 2012. doi:10.1016/S0140-6736(12)61031-9
World Health Organization. Global recommendations on physical activity forhealth. Switz. World Heal. Organ., Geneva, 2010.
NHagberg JM, Park JJ, Brown M. The role of exercise training in the treatment of hypertension: an update. Sport Med 2000;30:193-206.
Blake H, Mo P, Malik S, Thomas S. How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clinical Rehabilitation 2009. doi:10.1177/0269215509337449
Slentz CA, Houmard JA, Kraus WE. Exercise, abdominal obesity, skeletal muscle, and metabolic risk: evidence for a dose response. Obesity 2009. doi:10.1038/oby.2009.385
Zaccagni L, Barbieri D, Gualdi-Russo E. Body composition and physical activity in Italian university students. J Transl Med 2014. doi:10.1186/1479-5876-12-120
Berra K, Ripp J, Manson JE. Making physical activity counseling a priority in clinical practice: the time for action is now. JAMA − Journal of the American Medical Association 2015. doi:10.1001/jama.2015.16244
Centers for Disease Control. Physical activity and health: a report to the Surgeon General. Atlanta, GA: U.S. Department of Health and. Hum. Serv. Centers Dis. Control Prev. Natl. Cent. Chronic Dis. Prev. Heal. Promot. 1996.
Ross R, Freeman JA, Janssen I. Exercise alone is an effective strategy for reducing obesity and related comorbidities. Exerc Sport Sci Rev 2000.
Fedewa AL, Ahn S. The effects of physical activity and physical fitness on children’s achievement and cognitive outcomes:a meta-analysis. Res Q Exerc Sport 2011. doi:10.1080/02701367.2011.10599785
Sacheck JM, Kuder JF, Economos CD. Physical fitness, adiposity, and metabolic risk factors in young college students. Med Sci Sports Exerc 2010. doi:10.1249/MSS.0b013e3181c9216b
Greene GW et al.
Identifying clusters of college students at elevated health risk based on eating and exercise behaviors and psychosocial determinants of body weight. J Am Diet Assoc 2011. doi:10.1016/j.jada.2010.11.011
Nevill AM, Stewart AD, Olds T, Holder R. Relationship between adiposity and body size reveals limitations of BMI. Am J Phys Anthropol 2006. doi:10.1002/ajpa.20262
Butler SM, Black DR, Blue CL, Gretebeck RJ. Change in diet, physical activity, and body weight in female college freshman. Am J Health Behav 2004. doi:10.5993/AJHB.28.1.3
Scanlon L, Rowling L, Weber Z. ‘You don’t have like an identity you are just lost in a crowd’: forming a student identity in the first-year transition to university. J Youth Stud 2007. doi:10.1080/13676260600983684
Nelson MC, Story M, Larson NI, Neumark-Sztainer D, Lytle LA. Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change. Obesity 2008. doi:10.1038/oby.2008.365
Poobalan A, Aucott L. Obesity among young adults in developing countries: a systematic overview. Curr Obes Rep 2016. doi:10.1007/s13679-016-0187-x
Pollock ML et al.
The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine and Science in Sports and Exercise 1998. doi:10.1097/00005768-199806000-00032
Atlantis E, Ball K. Association between weight perception and psychological distress. Int J Obes 2008. doi:10.1038/sj.ijo.0803762
World Health Organisation. Global status report on noncommunicable diseases 2014. World Health 2014. doi:ISBN 9789241564854
Keating XD, Guan J, Piñero JC, Bridges DM. A meta-analysis of college students’ physical activity behaviors. J Am Coll Heal 2005. doi:10.3200/JACH.54.2.116-126
Sigmundová D, ChmelÍk F, Sigmund E, Feltlová D, Frömel K. Physical activity in the lifestyle of Czech university students: meeting health recommendations. Eur J Sport Sci 2013. doi:10.1080/17461391.2013.776638
Anokye NK, Lord J, Fox-Rushby J. Is brief advice in primary care a cost-effective way to promote physical activity? Br J Sports Med 2014. doi:10.1136/bjsports-2013-092897
Pribis P, Burtnack CA, Mckenzie SO, Thayer J. Trends in body fat, body mass index and physical fitness among male and female college students. Nutrients 2010. doi:10.3390/nu2101075
Warner ER, Fornetti WC, Jallo JJ, Pivarnik JM. A skinfold model to predict fat-free mass in female athletes. J Athl Train 2004.
van der Ploeg GE, Gunn SM, Withers RT, Modra AC. Use of anthropometric variables to predict relative body fat determined by a four-compartment body composition model. Eur J Clin Nutr 2003. doi:10.1038/sj.ejcn.1601636
Craig CL et al.
International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003. doi:10.1249/01.MSS. 0000078924.61453.FB
Majeed F. Association of BMI with diet and physical activity of female medical students at the University of Dammam, Kingdom of Saudi Arabia. J Taibah Univ Med Sci 2015. doi:10.1016/j.jtumed.2014.11.004
Sai A et al.
Factors affecting body image perceptions of female college students in urban Malaysia. Obes Med 2018. doi:10.1016/j.obmed.2018.06.004
Sirang Z et al.
Weight patterns and perceptions among female university students of Karachi: a cross sectional study. BMC Public Health 2013. doi:10.1186/1471-2458-13-230
Aziz J, Siddiqui Na, Siddiqui Ia, Omair A. Relation of body mass index with lipid profile and blood pressure in young healthy students at Ziauddin Medical University. J Ayub Med Coll Abbottabad 2001.
Yahia N, Achkar A, Abdallah A, Rizk S. Eating habits and obesity among Lebanese university students. Nut. J 2008. doi:10.1186/1475-2891-7-32
Youssef MHM, Mojaddidi M, El Bab MF, El Nabi WA, Salem M. Gender differences in body composition, respiratory functions, life style among medical students. Biomed Res 2015.
Al-Rethaiaa AS, Fahmy AEA, Al-Shwaiyat NM. Obesity and eating habits among college students in Saudi Arabia: a cross sectional study. Nutr J 2010. doi:10.1002/ppp.428
Ko M-S. The comparison in daily intake of nutrients, dietary habits and body composition of female college students by body mass index. Nutr Res Pract 2007. doi:10.4162/nrp.2007.1.2.131
House BT, Shearrer GE, Boisseau JB, Bray MS, Davis JN. Decreased eating frequency linked to increased visceral adipose tissue, body fat, and BMI in Hispanic college freshmen. BMC Nutr 2018. doi:10.1186/s40795-018-0217-z
Bano R, AlShammari EM, Almedan AH. Body mass index, percent body fat and visceral fat in relation to dietary fat and fiber intake among university females. Nutr Food Sci 2015;3:256-62.
Janssen I, Heymsfield SB, Wang Z, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol 2000. doi:10.1152/jappl.2000.89.1.81
Moses MO et al.
Examining and comparing the health and performance indices of university undergraduate students according to year of study and gender. J Exerc Rehabil 2017. doi:10.12965//jer.1735006.503
World Health Organization. Global physical activity questionnaire. NCDs (2010). doi:10.1002/dta.386
McGuire S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr An Int Rev J 2016. doi:10.3945/an.116.012211
Centers for Disease Control (CDC) and Prevention & Promotion. Nutrition, physical activity and obesity: data, trends and maps. Nutrition, Physical Activity and Obesity Data, Trends and Maps web site (2015).
Al-Hazzaa HM. Prevalence of physical inactivity in Saudi Arabia: a brief review. Eastern Mediterranean Health Journal 2004;10:663-70.
Awadalla NJ et al.
Assessment of physical inactivity and perceived barriers to physical activity among health college students, south-western Saudi Arabia. East Mediterr Heal J 2014. doi:10.26719/2014.20.10.596
Kerkadi A. Evaluation of nutritional status of United Arab Emirates university female students. Emirates J Food Agric 2003. doi:10.9755/ejfa.v15i2.5005
Al-Isa AN, Campbell J, Desapriya E, Wijesinghe N. Social and health factors associated with physical activity among Kuwaiti college students. J Obes 2011. doi:10.1155/2011/512363
Sharara E, Akik C, Ghattas H, Makhlouf Obermeyer C. Physical inactivity, gender and culture in Arab countries: a systematic assessment of the literature. BMC Public Health 2018. doi:10.1186/s12889-018-5472-z
Radu L-E., Făgăraş S-P., Vanvu G. Physical activity index of female university students. Procedia − Soc Behav Sci 2015. doi:10.1016/j.sbspro.2015.04.375
Abdullah AS, Wong CM, Yam HK, Fielding R. Factors related to non-participation in physical activity among the students in Hong Kong. Int J Sports Med 2005. doi:http://dx.doi.org/10.1055/s-2004-821315
El Gilany AH, Badawi K, El Khawaga G, Awadalla N. Physical activity profile of students in Mansoura University, Egypt. East Mediterr Heal J 2011. doi:10.26719/2011.17.8.694
Tappy L, Binnert C, Schneiter P. Energy expenditure, physical activity and body-weight control. Proc Nutr Soc 2003. doi:10.1079/PNS2003280
Ballor DL, Keesey RE. A meta-analysis of the factors affecting exercise-induced changes in body mass, fat mass and fat-free mass in males and females. Int J Obes 1991. doi:16167509
Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Fiatarone Singh MA. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr 2002. doi:10.1093/ajcn/76.2.473
DiPietro L. Physical activity, body weight, and adiposity: an epidemiologic perspective. Exerc Sport Sci Rev 1995;23:275–303.
Sowers MF, Crutchfield M, Jannausch ML, Russell-Aulet M. Longitudinal changes in body composition in women approaching the midlife. Ann Hum Biol 1996. doi:10.1080/03014469600004472
Murray LA. A longitudinal study of changes in body composition and basal metabolism in physically active elderly men. Eur J Appl Physiol Occup Physiol 1996. doi:10.1007/BF00838641
Boreham C et al.
Tracking of physical activity, fitness, body composition and diet from adolescence to young adulthood: the young hearts project, Northern Ireland. Int J Behav Nutr Phys Act 2004. doi:10.1186/1479-5868-1-14
Anderssen N et al.
Change and secular trends in physical activity patterns in young adults: a seven-year longitudinal follow-up in the Coronary Artery Risk Development in Young Adults study (CARDIA). Am J Epidemiol 1996. doi:10.1093/oxfordjournals.aje.a008749
Sims ST et al.
Changes in physical activity and body composition in postmenopausal women over time. Med Sci Sports Exerc 2013. doi:10.1249/MSS.0b013e31828af8bd
Colbert LH et al.
Physical activity, exercise, and inflammatory markers in older adults: findings from the health, aging and body composition study. J Am Geriatr Soc 2004. doi:10.1111/j.1532-5415.2004.52307.x
Peterson MJ et al.
Physical activity as a preventative factor for frailty: the health, aging, and body composition study. Journals Gerontol − Ser A Biol Sci Med Sci 2009. doi:10.1093/gerona/gln001
Westerterp KR, Speakman JR. Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals. Int J Obes 2008. doi:10.1038/ijo.2008.74
Speakman JR, Westerterp KR. Associations between energy demands, physical activity, and body composition in adult humans between 18 and 96 y of age. Am J Clin Nutr 2010. doi:10.3945/ajcn.2009.28540
Westerterp KR. Assessment of physical activity: a critical appraisal. European Journal of Applied Physiology 2009. doi:10.1007/s00421-009-1000-2
Wang J, Thornton JC, Kolesnik S, Pierson RN. Anthropometry in body composition: an overview. Ann N Y Acad Sci 2006. doi:10.1111/j. 1749-6632. 2000.tb06474.x
Powers SK, Howley ET. Exercise physiology − theory and application to fitness and performance. 2009. doi:0-07-255828-1
[Table 1], [Table 2], [Table 3], [Table 4]