Original Article Comparison of health promoting lifestyle profile among medical students of non-clinical and clinical years Fouzia Batool, Hania Farheen, Aqsa Rehan, Sania Kiani, ‘Amna Nadeem Departments of Physical Therapy, Shifa Tameer-e-Millat university and Riphah College of Rehabilitation Sciences, Riphah Intemational University, Islamabad, Pakistan Objective: To determine the health promoting lifestyle in medical students and to compare the differences in health promoting lifestyle between non-clinical and clinical years of study. Methodology: This was a descriptive cross- sectional study conducted on 311 medical students of Rawalpindi and Islamabad, Pakistan from July to December 2017. Non probability convenient sampling technique was used Students of both genders aged 18 to 25 years studying in 1" 2" 4"'5" years of medical colleges were included, while those with any chronic illness were excluded from the study. Standard questionnaire Health Promoting Lifestyle Profile —II (HPLP-II-) was used. The data were analyzed using SPSS version 21 Results: Out of 311 participants, 168(54%) were clinical and 143(46%) non-clinical. The mean age of the students in non-clinical group was 19,8621 ,265 years and clinical group was 22.78+ 0.815 years. There was no statistically significant (p>0.05) difference in the total mean and subscales score of health promoting lifestyle profile. Students scored their lowest mean in physical activity in both non-clinical (2.15+0.51) and clinical (2.0340.64) groups. The highest mean was recorded in spiritual growth in both clinical (2.78+0.55) and non-clinical (2,8040.49) group. Conclusion: Overall health promoting lifestyle profile of medical students was of medium level The highest and lowest means were observed in spiritual growth and physical activity, respectively. (Rawal Med J 201;44:840-843), Keywords: Health promoting lifestyle profile, medical students, nutrition, physical activity, spiritual growth INTRODUCTION Poor health is one of the leading causes of disease and disability worldwide.’* Lifestyle is the way of living of individuals, families and societies, which can be healthy or unhealthy depending upon their personal behavior towards nutrition, physical activity and stress management. *Self-behavior and health perception have an impact on person's happiness and well-being, whereas unhealthy lifestyles end with illness and morbidity."* University student's stage of growth is a channel between adolescence and adulthood.’ This period significant as it shows many changes in mind, body and relationships.’ It has been observed that these students engage themselves in many unhealthy habits like eating more junk food, physical inactivity and improper sleep.’ This develops negative lifestyle behaviors that continue with their later life and may result in bad consequences with theage.” 840 Recent studies showed that 60% of the students were insufficient in their physical activity, 47% was not taking balanced diet and 30% had low mental wellness.""” Universities not only provid academic leaming but they are the centers for development of individual personalities as well as for promoting health promoting lifestyle in students." Improving and protecting the health of population have now become the priority of healthcare." The change of lifestyle is one of the key factor in moving an individual towards the state of optimal health." Therefore, the purpose of this study was to determine health promoting lifestyle in medical students and to compare its differences between the non-clinical and clinical years of study. METHODOLOGY This was a descriptive cross sectional study conducted on 311 medical students of Rawalpindi and Islamabad from July to December 2017. The Rawal Medical Journal: Vol. 44. No. 4, Oct-Dec. 2019Comparison of health promoting lifestyle profile among medical students of non-clinical and clinical years, sample of the study was selected using non probability convenient sampling. Students of both genders aged 18 to 25 years studying in 1" 2" 4*™*5 years of medical colleges were included, while those with any chronic illness were excluded from the study. This study is approved by ethics committee of Riphah College of Rehabilitation Sciences, Islamabad and Informed consent of each individual was taken. Self-structured questionnaire was designed to collect the demographic data and BMI of the participants. Standard BMI classification (less than 18 underweight, 18.5-25 normal, 25-30 over- weight, 30-35 class I obesity and 35-40 class IL obesity) was used to categorize the students. Health promoting lifestyle was assessed using standard questionnaire Health Promoting Lifestyle Profile 1 (HPLP-I-)."* HPLP-II questionnaire has six sub scales with total of 52 questions. The six sub-scales are; (1) Health responsibility (HR), (2) Physical Activity (PA), (3) Nutrition (N), (4) Spiritual Growth (SG), (5) Inter- personal Relationship (IPR) and (6) Stress Management (SG). Physical activity and stress management has total of eight questions whereas, all the other scales has nine questions. The items of the questionnaire are scored as I(never), 2 (sometimes), 3 (often) and 4 (routinely). Each subscale score was interpreted by calculating the mean of responses in each subscale. Interpretation of results range in percentile (25th-75th) with low, medium and high level from 1.60- 2.25, 2.26-2.71, 2.72-3.27, respectively." The data were analyzed through SPSS version 21. For comparison between clinical and non-clinical groups, independent sample t test was applied on total mean score of health promoting lifestyle profile-II and on all six components (health responsibility, physical activity, nutrition, spiritual growth, inter-personal relationship and stress management). Level of significance was considered atp<0.08. RESULTS The total sample of 311 participants was divided into non-clinical (1" and 2 year) 143(46%) and clinical (4"and S* year) 168(54%) groups. In non- 841 clinical group, participation from 1* and 2" year students were 86(60.1%) and 57(39.9%), respectively. In clinical group, participation from 4" and 5" year students were 65(20.9%) and 103(33.1%), respectively. Total males and females in clinical group were 24(14,3%) and 144(85.7%), and non-clinical group were 42(29.4%) and 101 (70.6%), respectively. The mean age of the students in non-clinical group was 19.86+1.265 years and clinical group was 22.78:0.815 years. Fig. BMI between clinical and non-clinical students. ‘Clinical = Non-clinical 3156.6%) 82(48.8%)) 5935.1%) 4108.7%) 15(98%) 1518.9%) 814.8%) 14.9%) Class 1 Obesity Chass 2 Obesity ‘Underweight Normal Overweight ‘Table, Independent sample T test between clinical and non- clinical students. Health Promoting Lifestyle Profile-IL Non | Clinical Clinical Meant | Means | P- SD. SD. [Value Mean of HPLP I [2.45+0.35 [2.41+0.39 [0.359 Health Responsibility | 2.20.46 [2.15+0.48 [0.312 Physical Activity _[2.15+0.51[2.03+0.64[ 0.075 Nutrition 2.31:40,50 |2,240.46| 0.198 [Spiritual Growth [2.80.49 |2.7840.55] 0.704. Tnter-personal 2,640.49 2.7140.46] 0.315 Relationship ‘Stress management [2.5440.49 [2.512053] 0.625 Majority of the students were lying in normal category of BMI in both clinical 82 (48.8%) and non-clinical 81(56.6%) groups. (Fig.) In clinical group 146(86.9%) were living with their families and 22 (13.1%) were living in hostels whereas, in non-clinical group 125(87.4%) were living with Rawal Medical Journal: Vol. 44. No. 4, Oct-Dec. 2019Comparison of health promoting lifestyle profile among medical students of non-clinical and clinical years, their families and 18(12,6%) were living inhostels. HPLP II total mean score and six subclasses showed no statistically significant difference (p>0.05) between clinical and non-clinical groups. The highest mean was recorded in spiritual growth both in non-clinical (2.80+ 0.49) and clinical (2.78 0.55) groups (Table). DISCUSSION Itis generally believed that as student are promoted to the higher years, they become mature and show more concern towards their health, In our study, both groups fell in medium category of HPLP-II total mean score. These are similar to a Turkish study."* Further, the studies by Wei et al, Hosseini et al and Masina et al. also observed medium level of total HPLP-IT score among all the years of studies." Out of six dimensions of lifestyle promoting profile, the study showed highest mean in spiritual growth for both groups. The studies conducted by Nascar et al, Hosseini et al and Masina et al also showed highest mean in spiritual growth in all the academic years of studies."'*"* This might be due to strong religious faith, Further, with passage of time religious believes in the student's strengths due to direct link of students with the patients. However, study by Wei et al among Japanese students showed medium value of spiritual growth in all years.” Itcan be related to their different religious, ethical and cultural beliefs, As students enter university, their communication skills start getting improved. In this new level of study, presentations, group discussions and interaction with students of different backgrounds further enhance their interaction skills. Nascar et al showed interpersonal relationship of high category in first and last year, while Hosseini et al and Wei et al showed high Value of interpersonal relationship in all academic years.""** This might be due to differences in education system of both countries The mean value of stress management was of medium category. Students somehow start learning and adopting strategies of managing stress of studies and personal life during university period. Nacar et al. showed medium category in first and last year.” Wei et al showed high category in first 3842 year than students in other years,* Hosseini et al concluded medium category of stress management inall years.” Masina et al also showed that both first and second year mean of stress management was of mediumlevel." ‘The mean of nutrition was medium in non-clinical, while it was low in clinical group. Itcan be due to the reason that once students get involved in their medical studies, due to stress they do not focus on proper and balanced diet. Contrary to the results of our study, Nascar etal. Hosseini etal. and Wei etal. observed nutrition value of medium level in all academic years."""* The lowest mean was also observed in physical activity for both non-clinical and clinical groups. Students due to their sedentary lifestyles are less involved in physical activity and exercises that can be the reason of this lowest mean among all six domains of health promoting lifestyles behaviors, The studies conducted by Nascar et al and Hosseini etalalso showed lowest mean in physical activity in all years." Another study by Masina et al showed low and medium level mean in first and second year of studies." The difference in the result might be due to the reason that in these universities proper physical activity program is part of curriculum where this is lacking in our country. Further studies should be conducted with large sample size, As medical students go through different types of challenges at every level, therefore to become a good practitioner lifestyle modification in all domains of health promoting lifestyle profile is necessary and therefore should be encouraged. Universities should design a structured and programmed plan for their students. Different physical activities should be conducted in future to improve physical health, Stress coping strategies should also be the encouraged among students CONCLUSION The study concludes that overall health promoting, lifestyle profile for both groups of medical students is of medium level. The highest mean was observed in spiritual growth, whereas physical activity mean is lowest among all subscales of health promoting lifestyle profile. Rawal Medical Journal: Vol. 44. No. 4, Oct-Dec. 2019Comparison of health promoting lifestyle profile among medical students of non-clinical and clinical years, “Author Contributions ‘Conception and design: Fouzia Batool Colection and assembly of data: Aqsa Rehan ‘Analysis and interpretation ofthe data: Fouzia Batool, Amna Nadeem Drafting ofthe article: Hania Farhoen Catca revision of the article fr important intllactual content: Hania Farheen ‘Statstcal expertise: Sana Kian Final approval and guarantor of the article: Fouzia Batool Corresponding author emall Fouzia Baloo syedafouzlabatool@gmalcor Confit of interest: None declared Rec. Date: Sep 6, 2018 Revision Rec. Date: Sep 11,2019 Accept Date: Sep 25, 2019 REFERENCES 1. Belpomme D, Irigaray P, Sasco A, Newby J, Howard V, Clapp R, et al. The growing incidence of eancer: role of lifestyle and sereening detection, Int J Oncol 2007;30:1037-49, KromhoutD, Menotti A, Kesteloot H, Sans S. 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