1.

INTRODUCTION
The factor that plays vital role in health promotion is physical activity which is associated
with the reduction in the risks of psychological issues i.e. stress or anxiety and also
promotes the feeling of wellbeing. (1) Various factors that have been identified to
promote health in different populations are dietary habits, spiritual growth, attitude
towards health responsibility, relationships, stress management, and level of Physical
activity of the individual. 3 Despite of having enough knowledge about good health,
medical students still tend to avoid the healthy behaviors.(2)

The World Health Organization has provided guidelines to that an adult of age between
18-64 years should perform exercises of moderate intensity about 150/week minutes or
intense exercises about 75 minutes/week.4 Obesity and related issues could be overcome
by regular physical activity.(3)

There is correlation between physical health and mental health. A healthy mental status
promotes the healthy living. However, there is very little evidence of dependence of
mental health on physical activity.(4) However, medical education is considered to be
one of the most academically and emotionally demanding training programs out of any
profession. In the current literature anxiety among medical students is less studied than
depression.(5) Physical activity can attenuate the detrimental effects of sedentary
behavior and its association with all cause mortality. Achieving recommended levels of
physical activity is crucial to achieve the physiologic and psychosocial benefits
associated with physical activity and reduced the risk of several chronic diseases.(6)

Physical activity is regarded crucial for physical and mental health in young and mature
adults a reduction of physical activity in general population has been suspected during
Covid-19 crisis and could result in increase cardiovascular results. (7). Given the
importance of physical activity it is worrying that 1 in 5 adults globally are reported to be
physically inactive with higher prevalence among wealthier countries as well as women
and elderly. Physical inactivity thus become a major health problem and was identified
by the world health organization as 1 of the top 5 risk factors for global mortality. (8)

1
The adoption of an active lifestyle not only depends upon healthy individual behaviors
and choices but also on the interaction between individual’s environment and public
policies. A growing number of studies have shown that the environment, plays and
important role in promoting global physical activity or event specific behavior.(9)

The university students experience disturbances in their circadian cycle because of the
stress of academic environment which is increased by habits such as internet, watching
television, using alcohol and smoking. Improved sleep quality is associated with
engaging in sports and extra-curricular activities.(10)

Burn out is a state of emotional and physical exhaustion and is common among medical
students.(11)

The role of physical activities in promoting overall health is a well-established fact. To

create further awareness about it, it is very important to know the current status in
different strata of population. This study is meant to study the current status of various
health promoting practices and physical activity in both genders of medical students, who
in future ensures the well-being of general population.

2
 2. LITERATURE REVIEW
Gulden Aynaci et al. In year 2018 access the relationship healthy lifestyle behaviors and
systemic blood pressure in university students study was conducted on (N=200)
university students and blood pressure is measured from both arms by using health
promotion lifestyle profile 2 (HPLP). Individuals who mostly feel good have greater
HPLP-2 score than those individual who rarely feel good. Individuals which perform
social activities and nonsmokers have higher score. According to study blood pressure is
higher in males than females. The study concluded that overall health and lifestyle
improves with physical activities. (4)

Jouni kallio et al. In year 2020 access the changes in physical activity and sedentary time
during adolescence-weekdays and weekend days. By using accelerometer. The study was
conducted on (N=970) children in (4-7) grade between age of (10-13) years from nine
different schools in Finland. Hip worn accelerometer use for seven days to access the
time spent in vigorous physical activity(VPA) moderate vigorous physical activity
(MVPA) light physical activity (LPA) sedentary time (ST). MVPA decreased in boys
from 2.2 -60min per day per year but not in girls. ST increased in boys and girls both.
Physical activity decrease in boys greater than girls and in adolescence set increase more
in girls than boys mostly on weekend days. (12)

Anam sattar et al. Conducted cross sectional observational study in year 2016 to access
the level of physical activity and its association with health promoting practicing among
female medical students at Azra naheed medical college Lahore by using health
promoting lifestyle profile-2 scale and rapid assessment of physical activity scale-1.

3
Study concluded that 5.1 % female score sedentary and 44.4% female score active. Mean
value of physical activity scale -1 is mean SD = 4.74 +_ 1.89 and average score of health
promoting lifestyle profile -2 is 2.41 +_404. Study concluded that physical activity and
health promoting practices shows week correlation according to this study medical
females less are less active and there is no influence of health related activities on
physical activity. (2)

Taylor Mc fadden in year 2020 access the relationship between physical activity
participation and mental health profiles in Canadian medical students(latent profile
analysis using continuous latent profile indicators research conducted on (N= 125)
students by using latent profile indicators like(emotional, social, psychological wellbeing
and resilience) mental health profile shows low (n=18) moderate(n=72) high(n=36) self-
reporting rating of mental health study concluded that who perform more mild
(M=144.28min per week) (SD=22.12) and less moderate to vigorous physical activity has
high mental health profile than those who perform moderate and low profiles. Mild
physical activity plays integral role in improving mental health of students. (13)

Fatemeh kakouei et al. In year 2019 access the correlation between academic
achievement and healthy lifestyle behaviors in university students. Cross sectional study
was conducted on 262 students of Babol University of medical sciences by using
multistage sampling technique and health promotion lifestyle profile (HPLP) with six
domains to evaluate the healthful lifestyle activities. The study concluded that spiritual
growth (p=0.043) and living situation (p=10.0) are main factors effects the academic
achievement. (14)

Mustafa calik ET al.with the help of department of emergency sciences and university
health sciences (uhs) conducted study to determine the anxiety and anxiety levels of
university students during covid-19 outbreak. Research was conducted on 1117 students
(15 public and 18 private) between 17 to 23 years of age by using likert type
questionnaire which include beck anxiety inventory-1(BAI) and state trait anxiety
inventory-1(STAI-1) participants fill questionnaire online. Research concluded that BAI

4
score of male 11.5 and female 10.65 and average STAI score of male = 46,71 and female
= 40.04 huge difference between male and female values end result of study is that more
than half of university students gone through severe anxiety symptoms during the covid-
19 outbreak. (15)

P macilwraith et al. In year 2018 conducted a cross sectional study to access the
relationship between burnout and physical activity in medical students. Research was
conducted on (N=383) students at university college Cork by using Maslach burnout
inventory student survey scale (MBI-SS) and international physical activity questionnaire
(IPAQ). Result of study states that on (MBI-SS) high level of emotional exhaustion(EE)
is present in 44.8% of students and 25.6% reported increased level of cynicism and
decreased level of professional efficacy(PE) on (IPAQ) 53.23% of students involve in
health enhancing physical activity(HEFA-active). Study concluded that positive
correlation exist between (EE) and cynicism scores and week negative relation exist
between professional efficacy and cynicism and weak positive correlation in professional
efficacy and physical activity levels. (16)

Amir roof memon in the year 2018 conducted randomized control trial to study the
effectiveness of an incentivized physical activity program among female medical students
in Pakistan. Incentive based approach unite with smartphone application to encourage
physical activity and weight loss in female medical students. Two groups are made
incentivized group no- incentivized group through random allocation of members. study
concluded that Group with financial incentive associated with the smart phone
application not show increase in physical activity (p > 0.05) but weight loss seen in both
groups. From week 4 and 5 there is decreased in number of steps are seen in intervention
group as compared to the baseline physical activity (p<0.01) End result of study shows
that financial incentive group with smart phone app which used to track physical activity
did not encourage physical activity or decreased obesity. (17)

Miwako nagasu in year 2019 study the association of socioeconomic and lifestyle related
risk factors with mental health conditions. Cross sectional study was conducted on
(N=3085) participants in both genders by using Japanese version of 12 item general
health questionnaire (GHO-12). Results shows score of 4 or more present in 33.4% of

5
males and 40.4% of female. Score is inversely proportional to men annual household
disposal income in male income less than 2million shows higher scores than greater than
2 million on the other hand in female’s lower income of less than 2million indicates poor
mental health. Study concluded that there is strong relationship between low level of
household disposal and poor mental health. (18)

Erin E- ayala in year 2017 study the prevalence perceptions and consequences of
substance use in medical students. Research was conducted on (N=855) students from 49
medical students in US by using online questionnaire. Result shows that 91.3% or 20.2%
medical students involved in alcohol consumption intake marijuana use frequently seen.
In last few years it is seen that students take 5 or more drinks in one sitting 40% of
students even do not know about their medical school rules regarding substance use. In
students drug use leads to suicidal thoughts cognitive dysfunction which compromised
academic performance of students. (19)

Amani alhazmi at el. In year 2020 study the dietary assessment and its awareness in
female students from different health departments like medicine surgery, radiology,
nursing, pharmacy, physiotherapy. Cross sectional study was conducted on (N=377)
females by using online questionnaire that includes information related to diet and food
intake. Comparison of nutrition awareness among different departments are seen. Results
shows huge difference in BMI (p<0.05) in medicine and surgery department greater BMI
recorded and physiotherapy students are overweight and no obese student are seen in
nursing department. (20)

6
 3. RATIONALE OF THE STUDY

There are number of studies that shows the impact of inactivity and sedentary life on
health. The purpose of this study is to check association between level of physical
activity of medical students on health and health promoting practices.

7
 4. OBJECTIVE

To study the association between physical activity and health promoting activities in
young medical students.

8
 5. HYPOTHESIS

Null Hypothesis:

There is no association between physical activity and health promoting practices.

Alternative Hypothesis:

There is association between physical activity and health promoting practices.

9
 6. OPERATIONAL DEFINITIONS
Physical Activity:

Any physical movement produced by skeletal muscles with utilization of energy.

Health:

A term that explains the physical and mental condition of a person specifically regarding
to the illness.

Health promoting activities:

Activities that is used to increase awareness among individuals to improve their overall
health condition.

Health promoting lifestyle profile tool:

It is a tool used to assess health promoting behaviors among individuals based on six
sub-scales.

10
 7. MATERIAL AND METHODS

7.1. Study Design: Cross-sectional study.

7.2. Setting: Akhtar Saeed Medical and Dental College Lahore.

7.3. Study Duration: 6 months.

7.4. Sample Size: Sample size is calculated using the six-sigma formula
𝑛 = ((𝑧𝛼/2) (𝜎)/𝐸) 2
Zα/2 = 1.96
Confidence interval= 95%
Level of significance α = 5% = 0.05
Percentage of Population selected= 40%

11
 Sample size = 24

7.5. Sampling Technique: Convenience sampling

7.6. Sample Selection:

7.6.1. Inclusion Criteria:

Age 19-25 year
Gender both male and female
Students of first to final year from different domain of medical profession
Healthy population

7.6.2. Exclusion Criteria:

Any recent surgery
History of recent trauma
Psychological disorder
Any chronic illness or congenital abnormalities

7.7. Equipment/ Tool: Where needed

Tools:
Health promoting lifestyle profile 2
Rapid assessment of physical activity 1
Rapid assessment of physical activity 2

12
7.8. Data Collection Procedure

The data was collected by the standard questionnaire comprised of health

lifestyle profile 2 and rapid assessment physical activity. The questionnaire was
distributed among 24 males and females and medical students of Akhtar Saeed
medical and dental college.

Variables:
Physical activity
Health promoting habits.

13
 7.9. Data Analysis:

The data was analyzed using SPSS version 21 frequency mean and standard deviation
was calculated for the health promoting life style profile scale and rapid assessment of
physical activity tool was used as outcome measure tool chi-square test was used to
measure the correlation between health promoting practices and physical activity level. P
value of < 0.05 was considered significant.

14
7.10. Ethical Considerations

15
The rules and regulations set by the ethical committee of Akhtar Saeed Medical and
Dental College were followed while conducting the research and the rights of the
research participants were respected.

● Informed consent was taken from all the participants.

● All information and data collection was kept confidential.
● Participants remained anonymous throughout the study.
● The subjects were informed that there were no disadvantages or risk on the procedure
of the study.
● They were informed that they are free to withdraw at any time during the process of
the study.
● Data was kept secured.

16
 8. RESULTS

Age of Participant

Cumulative
Frequency Percent Valid Percent Percent

Valid 19-21 10 40.0 41.7 41.7

22-25 14 56.0 58.3 100.0

Total 24 96.0 100.0

Missing System 1 4.0
Total 25 100.0

I rarely or never do any physical activities?

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 5 20.8 20.8 20.8

No 19 79.2 79.2 100.0

Total 24 100.0 100.0

17
 I do some light or moderate physical activities but not every week.

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 16 66.7 66.7 66.7

No 8 33.3 33.3 100.0

Total 24 100.0 100.0

18
 I do some light physical active every week.

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 15 62.5 62.5 62.5

No 9 37.5 37.5 100.0

Total 24 100.0 100.0

19
 I do moderate physical activities every week but less than 30 minutes a
day or 5 days a week.

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 12 50.0 50.0 50.0

No 12 50.0 50.0 100.0

Total 24 100.0 100.0

20
 Choose a diet low in fats, saturate fats and cholesterol.

Cumulative
Frequency Percent Valid Percent Percent

Valid Never 7 29.2 29.2 29.2

Sometimes 8 33.3 33.3 62.5

Often 8 33.3 33.3 95.8

Routinely 1 4.2 4.2 100.0

Total 24 100.0 100.0

21
 Spend time with close friend.

Cumulative
Frequency Percent Valid Percent Percent

Valid Never 1 4.2 4.2 4.2

Sometimes 4 16.7 16.7 20.8

Oftenly 5 20.8 20.8 41.7

Routinely 14 58.3 58.3 100.0

Total 24 100.0 100.0

22
 Take part in Recreational activities such as swimming,dancing and bicycling.

Cumulative
Frequency Percent Valid Percent Percent

Valid Never 4 16.7 16.7 16.7

Sometimes 13 54.2 54.2 70.8

Oftenly 5 20.8 20.8 91.7

Routinely 2 8.3 8.3 100.0

Total 24 100.0 100.0

23
24
 9. Discussion:

Anam sattar et al. Conducted cross sectional observational study in year 2016 to access
the level of physical activity and its association with health promoting practicing among
female medical students at Azra naheed medical college Lahore. Mean value of physical
activity scale -1 is mean SD = 4.74 +_ 1.89 and average score of health promoting
lifestyle profile -2 is 2.41 +_404. Study concluded that physical activity and health
25
promoting practices shows week correlation according to this study medical females less
are less active and there is no influence of health related activities on physical activity.
The current study showed that there is insignificance between physical activity and health
promoting practices.1

gulden Aynaci et al. In year 2018 access the relationship healthy lifestyle behaviors and
systemic blood pressure in university students study was conducted on (N=200)
university students and blood pressure is measured from both arms by using health
promotion lifestyle profile 2 (HPLP). Individuals who mostly feel good have greater
HPLP-2 score than those individual who rarely feel good. Individuals which perform
social activities and nonsmokers have higher score. According to study blood pressure is
higher in males than females. The study concluded that overall health and lifestyle
improves with physical activities. The current study showed that physical activity was not
co-related with health promoting practices. 11

Fatemeh kakouei et al. In year 2019 access the correlation between academic
achievement and healthy lifestyle behaviors in university students. Cross sectional study
was conducted on 262 students of Babol University of medical sciences by using
multistage sampling technique and health promotion lifestyle profile (HPLP) with six
domains to evaluate the healthful lifestyle activities. The study concluded that spiritual
growth (p=0.043) and living situation (p=10.0) are main factors effects the academic
achievement. The current study however showed no significant association between
physical activities and health promoting practices.14

10.CONCLUSION
The study concluded that there is no association between health promoting practices and
physical activity in medical students.

26
 11.LIMITATIONS
Small sample size due to COVID.

Limited time duration

27
 12.RECOMMENDATIONS

The study is done using small sample size. Further studies can be done using large
sample size and in different population or in any other setup

28
 13.REFERENCES

Vancouver style
Examples:

JOURNAL
Gharaee N, Pourali L, Jafarian AH, Hashemy SI. Evaluation of serum level of substance
P and tissue distribution of NK-1 receptor in endometrial cancer. Molecular biology
reports. 2018 Dec 1; 45(6):2257-62.

BOOK
Mason J. Concepts in dental public health. Philadelphia: Lippincott Williams & Wilkins;
2005)
Note: Minimum 40 References

29
 14.APPENDIX

APPENDIX A: CONSENT FORMS

Consent Form in English

You are invited to participate in a research study conducted by Amna Mehboob, entitled
Physical activity and health promoting practices among medical students.

Risks and Discomforts

No risks and any sort of discomfort is associated with research.

Protection of Confidentiality

I will do everything to protect your privacy. Your identity will not be revealed in any publication
resulting from this study.

Potential Benefits

Participation in this research will let you to help us in concluding the importance of two physical
therapy tools.

Voluntary Participation

Your participation in this research study is voluntary. You may choose not to participate and you
may withdraw your consent to participate any time. You will not be penalized in any way should
you decide not you participate or to withdraw from this study.

CONSENT

I have read this consent form and have been given the opportunity to ask questions. I give
my consent to participate in this study.

Participant’s Signature __________________ Date: ____________________

A copy of this consent form should be given to the participant.

30
 ‫‪Consent Form in Urdu‬‬

‫ریسرچ سٹڈی_ میں شرکت کا دعوت نام‬

‫‪:‬ریسرچ کا عنوان‬

‫آپکو اس ریسرچ میں شمولیت کی دعوت دیتی ہوں میں‪-‬‬

‫‪-‬نقصانات اور تکلیف‪ :‬اس تحقیق سے کسی قسم کے نقصان یا تکلیف کا اندیشہ نہیں‬

‫‪-‬ممکنہ فوائد‪ :‬آپکو ایک اہم تحقیق میں حصہ لینے کا موقعہ دیا جاۓ گا‬

‫رازداری کا تحفظ‪ :‬ڈیٹا انٹری تجزیےکے دوران اور اس تحقیق کے نتیجے میں شائع ہونے والی کسی بھی اشاعت میں آپ‬
‫‪-‬کی شناخت کو ظاہر نہیں کیا جاے گا‬

‫رضاکارانہ شمولیت‪ :‬اس تحقیقی مطالعہ میں آپ کی شرکت رضاکارانہ ہے۔ آپ کو شرکت نہ کرنے اور کسی بھی وقت‬
‫بغیر وجہ بتانے اس تحقیق میں شمولیت کو چھوڑنے کا اختیار ہے۔‬

‫‪-‬درج ذیل معلومات تحقیق میں شامل ہونے کے لیے پڑھیں‬

‫میں نے معلوماتی شیٹ جو کہ تحقیق کی وضاحت کر رہی ہے کو سمجھ لیا ہےاورمجھے_ تحققیق کےبارے ميں سواالت‬
‫‪-‬کرنے کا موقع دیا گیا تھا‬

‫میں سمجھ_ گيی‪ /‬گیا ہوں کہ میری شرکت رضاکارانہ ہے اور یہ کہ میں کسی بھی وقت اپنا ارادہ بدل سکتی‪/‬سکتا ہوں اور‬
‫‪-‬تحقیق سے دستبردار ہوسکتی‪/‬سکتا ہوں‬

‫میں سمجھ_ گیی‪ /‬گیا ہوں کہ میرے جوابات خفیہ رکھے جاءیں گے ۔ میں محقیقیين کو اس بات کی اجازت دیتی‪ /‬دیتا ہوں کہ‬
‫‪-‬وہ جوابات کو جانچ سکیں‬

‫‪-‬میں اس بات سے رضامند ہوں کے جو معلومات مجھ سے لی گی ہيں وہ تحقیق میں استعمال ہوں گی‬

‫رضا مندی‪:‬ميں نے يہ اجازت نامہ پڑھا ہے اور مجھے سوال پوچھنے کا موقع ديا گيا ہے۔ ميں اس سٹڈی ميں شرکت کے‬
‫‪-‬راضی ہوں‬

‫___________ شرکت کنندہ کا نام __________________ دستخط____________________ تاريخ‬

‫‪APPENDIX B‬‬

‫‪Gantt Chart‬‬

‫‪31‬‬
 Months

01 02 01 02

Activity September (2021) October- December January-

November (2021) February(2022)
(2021)

Synopsis Submission

& Synopsis Defense

Data Collection

Data Analysis &

Interpretation

Thesis Compilation &

Submission

32
 APPENDIX C

Questionnaire

33
34
35
36
37
1. Breda J, Jakovljevic J, Rathmes G, Mendes R, Fontaine O, Hollmann S, et al. Promoting
health-enhancing physical activity in Europe: Current state of surveillance, policy development
and implementation. Health Policy. 2018;122(5):519-27.
2. Sattar A, Ehsan S, Mahmood T, Khalil R, Arshad S. Physical activity and health-promoting
practices among female medical students. Nutrition. 2019;2(516):4.
3. Avdagić SC, Barić IC, Keser I, Cecić I, Šatalić Z, Bobić J, et al. Differences in peak bone
density between male and female students. Arh Hig Rada Toksikol. 2009;60(1):79-86.
4. Galper DI, Trivedi MH, Barlow CE, Dunn AL, Kampert JB. Inverse association between
physical inactivity and mental health in men and women. Medicine & Science in Sports &
Exercise. 2006;38(1):173-8.
5. Tian-Ci Quek T, Tam W-S, X Tran B, Zhang M, Zhang Z, Su-Hui Ho C, et al. The global
prevalence of anxiety among medical students: a meta-analysis. International journal of
environmental research and public health. 2019;16(15):2735.
6. Luciano F, Cenacchi V, Vegro V, Pavei G. COVID-19 lockdown: Physical activity, sedentary
behaviour and sleep in Italian medicine students. European Journal of Sport Science.
2021;21(10):1459-68.
7. Steffen J, Schlichtiger J, Brunner S, Huber BC. Health promoting behaviour of medical
versus non-medical students during COVID-19 pandemic: results from the COLA cross-sectional
study. Journal of Translational Medicine. 2021;19(1):1-5.
8. Chew EJC, Ho YN, Kee GJ, Sirisena D. Scoping review and international multi-centre
cohort study investigating teaching, knowledge and beliefs regarding physical activity as a health
intervention among medical students: a comparison between Singapore and the UK. Singapore
Medical Journal. 2019;60(12):642.
9. Andrade ACdS, Mingoti SA, Fernandes AP, Andrade RGd, Friche AAdL, Xavier CC, et al.
Neighborhood-based physical activity differences: Evaluation of the effect of health promotion
program. PLoS One. 2018;13(2):e0192115.
10. Corrêa CdC, Oliveira FKd, Pizzamiglio DS, Ortolan EVP, Weber SAT. Sleep quality in
medical students: a comparison across the various phases of the medical course. Jornal
Brasileiro de Pneumologia. 2017;43:285-9.
11. Lee K, Yeung N, Wong C, Yip B, Luk LH, Wong S. Prevalence of medical students’ burnout
and its associated demographics and lifestyle factors in Hong Kong. PLoS One.
2020;15(7):e0235154.
12. Kallio J, Hakonen H, Syväoja H, Kulmala J, Kankaanpää A, Ekelund U, et al. Changes in
physical activity and sedentary time during adolescence: Gender differences during weekdays
and weekend days. Scandinavian journal of medicine & science in sports. 2020;30(7):1265-75.
13. McFadden T, Fortier M, Sweet SN, Tomasone JR. Physical activity participation and
mental health profiles in Canadian medical students: latent profile analysis using continuous
latent profile indicators. Psychology, Health & Medicine. 2021;26(6):671-83.
14. Bakouei F, Omidvar S, Seyediandi SJ, Bakouei S. Are healthy lifestyle behaviors positively
associated with the academic achievement of the university students? Journal of Advances in
Medical Education & Professionalism. 2019;7(4):224.
15. Çalık M. Determining The Anxiety And Anxiety Levels Of University Students In The
COVID 19 Outbreak. International Journal of Medical Science and Clinical Invention.
2020;7(7):4887-94.
16. Macilwrait P, Bennett D. Burnout and physical activity in medical students. Irish medical
journal. 2018;111(3):707.

38
17. Memon AR, Masood T, Awan WA, Waqas A. The effectiveness of an incentivized physical
activity programme (Active Student) among female medical students in Pakistan: A Randomized
Controlled Trial. J Pak Med Assoc. 2018;68:1438-45.
18. Nagasu M, Kogi K, Yamamoto I. Association of socioeconomic and lifestyle-related risk
factors with mental health conditions: a cross-sectional study. BMC public health. 2019;19(1):1-
13.
19. Ayala EE, Roseman D, Winseman JS, Mason HR. Prevalence, perceptions, and
consequences of substance use in medical students. Medical education online.
2017;22(1):1392824.
20. Alhazmi A, Aziz F. Dietary assessment and its awareness in female students from
different Health Departments: Unhealthy diet with normal BMI. Journal of Public Health
Research. 2020;9(3).

39