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Abstract:
Background: Physical inactivity is considered a problem with a great impact on morbidity and mortality. There is a necessity to combat this behavior through an assessment of barriers and benefits perceived by subjects. Objectives: The current study aimed to measure exercise intention, in addition to identifying physical exercise predictors, including perceived barriers and benefits among healthcare providers (HCPs) in Ain Shams University Hospitals. Methods: A cross-sectional study was performed on a sample of healthcare providers (physicians and nurses) in Ain Shams University Hospitals in Cairo, Egypt using anonymous self-administrated questionnaires. Results: Out of 327 healthcare providers approached, 52.6% of them were males and the mean age of participants was (29.34 + 7.84 years). Physical exercise was reported by 44.6% of participants. The most significant factors associated with physical exercise engagement were male gender, participants with lower body mass index (BMI), and those with higher perceived life enhancement subscale benefit scores and lower perceived Exercise milieu and Physical exertion barriers subscale scores. Exerciser showed significantly higher total overall (benefits and barriers) score compared to non-exerciser. Physicians showed a significantly higher total score compared to nurses. Conclusion and Recommendations: The prevalence of regular exercise is low and inversely related to the female gender, BMI, Exercise milieu, and Physical exertion barriers subscale scores, and directly related to life enhancement benefit subscale scores. Health education program about the benefits and barriers of exercise is recommended to encourage healthcare personnel to follow a healthy lifestyle and be role model to their patients and act as health promoters to them.
Keywords: Exercise, prevalence, benefits, barriers.
Introduction:
Regular physical activity (PA) is considered a leading health indicator in Healthy people 2010. 1 As regular participation in physical activity, especially in the form of exercise, leads to many benefits either physical (physiological, morphological) and psychological as well.2
Lack of physical activity is known to be one of the most important risk factors leading to morbidity and mortality around the world leading to an estimated 3.2 million deaths globally.3 Raised BMI could be one of the main risk factors associated with non-communicable diseases such as cardiovascular diseases, which were the leading reason for death in 2012; musculoskeletal disorders; several types of cancer (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon). In 2016, over 1.9 billion adults were overweight. Of these over 650 million were obese. 4 WHO estimated that between 2% and 7% of healthcare spending in developed economies can be attributed to obesity .5
Therefore, World Health Organization (WHO) recommends that all adults ought engage in regular exercise that’s outlined as ‘any planned physical activity (e.g. brisk walking, aerobics, jogging, bicycling, swimming, rowing, etc.) performed to increase physical fitness. Such activity ought to be performed 3 to 5 times per week for 20-60 minutes per session.6
Despite the awareness of these facts prevalent in the community, it does not lead to greater participation in exercise. As it is a complex behavior, dependent on many factors, such as personality (cognitive, emotional, motivational domain) and others in the environment, both physical and social. 2
Although, the explanation of the reasons that hinder individuals from participating in sufficient PA is complicated and multi-factorial; but, it is considered a high priority to convince people to invest time and money in an activity. Participation in physical exercise depends on perceived benefits and barriers. Perceived benefits represent a supportive or reinforcing consequence of a behavior. They may be intrinsic (such as improved alertness or diminished fatigue) or extrinsic (such as social acceptance or financial awards). The motivational value of perceived benefits is based on outcomes of previous personal experience or outcomes observed by others. While perceived barriers to action are associated with the obstacles encountered with undertaking a specific behavior as unavailability, inconvenience, expense, difficulty, time, or personal cost. Perceived barriers may either prevent the starting or initiation of a new activity or decrease commitment and adherence to the current activity. Amelioration of different barriers and increasing the perception of benefits by individuals will increase participation. 7
Health care workers are responsible for counseling appropriate health behaviors including physical activity. Personal physical activity among physicians and nurses and its reflection on their body built influence to some degree their exercise counseling as they are considered role models to their patients and community. 8 Therefore, healthcare workers may be seen as more truthful by their patients if they are following their own health promotion advice.9, 10
Thus, this study was conducted aiming to measure exercise prevalence, perceived barriers, and benefits of exercise among healthcare providers (HCPs) in Ain Shams University Hospitals in order to promote effective physical activity among healthcare providers and their patients.
Material and Methods:
- Study design and setting: A cross-sectional study was carried out among healthcare providers (physicians and nurses) in Ain Shams University Hospitals in Cairo, Egypt.
- Study duration: the study was conducted from January 2018 to August 2019
- Sampling method: A convenience sampling technique was used.
- Sample size: It was calculated using the PASS II program for sample size calculation and according to (Jamil et al., 2015), the expected prevalence of moderate physical exercise among healthcare providers = is 68%, assuming prevalence in the study population = 70% + 10%; a sample size of 323 HCWs can detect this prevalence with 95% confidence level. 11
- Data collection tool: Anonymous, self-administrated questionnaire was used, delivered in a written form to our study participants; the questionnaire was composed of:
- Socio-demographic data (e.g. age, occupation, education&etc.).
- Self-reported weight and height
- Intention to physical activity: whether the participant exercised or intended to exercise regularly was assessed using the Stages of Change (SoC) short-form questionnaire. Regular exercise is defined according to WHO as ‘any planned physical activity performed to increase physical fitness. Such activity ought to be performed three to five times per week for 20-60 minutes per session. Exercise does not need to be painful to be effective however ought to be done at a level that will increase your respiratory rate and causes you to interrupt a sweat. Answer choices; categorized answers as not intending to exercise regularly (pre-contemplation stage), intending to exercise regularly in the next six months or 30 days (contemplation and preparation stage, respectively), and patients exercising regularly for less or more than six months (action and maintenance stage, respectively). 12,13
The Exercise Benefits and Barriers Scale (EBBS: Sechrist et al. 1987) consists of 40 items, demonstrating the benefits and barriers that people associate with exercising. This scale is a 4-point Likert scale, from 1 (strongly disagree) to 4 (strongly agree). Barrier Scale items are reverse-scored. The possible scores on the benefits scale ranged from 29 to 116 points, with higher scores indicating greater benefits. The possible range of scores on the barriers scale was 14 to 54 points, with a higher score indicating fewer perceived barriers. The total overall score was calculated by the addition of benefits and barriers scores. It ranged from 43 to 170 points. The higher the score, the more positive physical activity benefits were perceived in relation to physical activity barriers. The reliability of this scale was established and Cronbach’s alpha was 094
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