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10,000 reasons to step out--exercise patterns and pedometer evaluation of consultant anaesthetists.

SUMMARY

Major international bodies recommend that adults should accumulate at least 30 minutes of moderate intensity physical activity every day. Ten thousand steps a day has been found to approximate 30 minutes of exercise. A questionnaire regarding exercise patterns was sent to all (584) Victorian consultant anaesthetists, and 30 consultants wore a pedometer for one week, during working hours only. The questionnaire response rate was 59.4% (347). Of these respondents, 58% indicated that they had a formal exercise program. There were no significant differences between people with a set exercise program and those without, with respect to age, gender, working hours or smoking. Those with a set exercise program exercised a median of four times per week and the commonest exercise listed was gymnasium attendance (40%). The main reasons cited for having a regular exercise program were maintenance of physical health (77%), mental health (71%) and weight control (35%). The main reasons for not having an exercise program were fatigue (40%), too busy (70%), family commitments (67%) or just not interested (18%). The overall median steps per day for the pedometer group was 4770 with a range of 1667 to 9630, fitting into the classification of 'sedentary'. In summary this study has shown that a significant number of anaesthetists do not achieve adequate physical activity in or out of working hours and has identified some reasons for this behaviour. This will hopefully provide motivation and information for the implementation of useful strategies to increase the level of physical activity performed by anaesthetists.

Key Words: exercise, pedometer, anaesthetist

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Research in the last 15 years has suggested positive correlations between physical activity and the lowering of the risk and progression of chronic diseases such as coronary artery disease, hypertension, type II diabetes, obesity, osteoporosis and markers of psychological health (1-5).

The current recommendation from the Centres for Disease Control and Prevention in the united States is that adults should accumulate at least 30 minutes of moderate intensity physical activity every day in order to obtain these health benefits1. Evidence also suggests that this could be performed all in one session or divided up into short bouts (6).

Examples of 'moderate physical activity' are 1) walking briskly at 3 to 4 mph, 2) cycling for pleasure at 10 kmph, 3) swimming with moderate effort, 4) conditioning exercise (callisthenics), 5) golf (general), 6) fishing (general, standing/casting), 7) canoeing for pleasure, 8) general house cleaning, 9) mowing the lawn, and 10) home repairs (painting, plastering, cleaning gutters, carpentry) (7).

In the u.S.A., according to the Surgeon general's Report on Physical Activity and health (8), only 22% of American adults are physically active at this level and 25% are completely sedentary in their leisure time. Factors associated with the likelihood of adequate physical activity were being male, young and in a higher socioeconomic group. In a study of American college students (9), the most commonly cited reasons for engaging in physical activity were health, fitness, and enjoyment of the activity.

This low participation rate may represent the mistaken belief by many people that in order to reap the health benefits they must engage in vigorous, continuous exercise. In order to improve the amount of physical activity and consequently the health of adults, there has been a world-wide promotion of exercise campaigns. Ten thousand steps have been found to approximate 30 minutes of exercise and the catchy slogan '10,000 Steps/Day' has been adopted by many countries, including Australia, to promote physical activity.

Pedometers, which are simple and inexpensive body-worn motion sensors, are being used by researchers and practitioners to assess and motivate physical activity. Recent studies show that health indicators such as body mass index, waist circumference, resting heart rate and diastolic blood pressure generally demonstrate an inverse correlation with the total number of steps taken daily (10,11). Furthermore, walking more than 9,000 steps per day increases the likelihood of being within the normal weight range, whilst walking less than 5,000 steps per day increases the likelihood of the subject being classified as 'obese' (10,11).

The National heart Foundation of Australia has used pedometers to investigate the number of steps taken daily by a variety of different working groups. They concluded that only 57% of the Australian population achieves sufficient physical activity for health benefits, that the accumulation of 30 minutes of moderate intensity physical activity every day halved the risk of heart disease, that blue-collar workers are twice as active as white-collar workers, and that no occupation achieves adequate physical activity at work alone to obtain health benefits (Andrew Mark, Regional health Promotion Coordinator, National heart Foundation of Australia, N.S.W. Division, communication).

In view of the recognised health benefits of exercise, we decided to study the exercise pattern of anaesthetists. The aims of our study were to 1) investigate the exercise patterns of practising anaesthetists and relate these to work and demographic characteristics and 2) quantitate the number of steps walked in a typical working day in anaesthetic practice.

METHODS

Approval for this research project was granted by St. Vincent's hospital Ethics Committee and permission was obtained from The Australian and New Zealand College of Anaesthetists. A survey investigating exercise patterns and influencing factors (Appendix A) was mailed out via the ANZCA registry to all Victorian consultant anaesthetists.

To quantify the number of steps taken in a typical working day, 30 consultants at St. Vincent's hospital (Melbourne) were recruited to wear a pedometer ('Pedometer 340', Sportline., Yonkers, NY) during working hours for five days. This duration of time was chosen so that the results for at least three full working days could be analysed. A 'full working day' was defined as the normal working day for the anaesthetist involved. Other pedometer studies have demonstrated that a test-retest reliability for a three-day protocol sample (separated by one month) resulted in an intra-class correlation of 0.91 (10).

The pedometers were sealed to 'blind' the wearer to the number of steps taken. Participants were instructed to place the pedometer over their anterior superior iliac spine on their waist belt. The pedometer was worn only during working hours. Each pedometer was checked for accuracy between each participant. This check was performed by an investigator wearing it for a known distance. The results of each participant over the three days were averaged, to give a value for the number of steps taken per day.

Statistical analysis

Nominal data were compared using Fisher's Exact test or Chi Square test. Other data were compared using Mann-Whitney tests. A P value of <0.05 was considered significant.

RESULTS

Questionnaires were sent to all ANZCA registered specialist anaesthetists within Victoria at the time of the investigation (n=584). Within two months, 360 forms had been returned, giving a response rate of 61.6%. Only 347 (59.4%) questionnaires were used, as the other 13 respondents were no longer practising anaesthesia.

Of the 347 responses analysed, 79% were male and 21% were female, with only 4% being smokers. The age distribution is shown in Figure 1. The median age was 46 years. Male respondents were significantly older than females (median 47 vs 43, P=0.02).

Overall, 72% of the respondents were in full-time practice (81% of males vs 41% of females, P<0.001). The median number of hours worked per week was 46 hours, with 79% working greater than 40 hours per week (Figure 2). Males worked significantly longer hours than females (median 48 vs 40, P<0.001). Respondents in full-time practice worked a median of 48 hours per week, compared to 36 hours per week for part-timers (P<0.001).

Hours worked per week varied significantly with age, rising from a median of 45 hours in the 30 to 35 year age group, to a median of 48 hours in the 41 to 45, 46 to 50 and 51 to 55 year age groups. They then fell with increasing age over 55 years to reach a median of 40 hours per week in the over 65-years-old group.

A set exercise program during the week was reported by 58% of the respondents. There were no significant differences between people with a set exercise program and those without, with respect to age, gender, working hours and smoking.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Those who had a set exercise program exercised a median of 4 times per week (10th to 90th interpercentile range: 2 to 7 times per week). The commonest exercise listed was gymnasium attendance (40%) Figure 3).

Males were more likely to cycle compared to females (28% vs 7%, P=0.003) and females were more likely to go to a gym (53% vs 35%, P=0.03). Walking and golf was more favoured in the older age groups (P=0.004, P=0.04) and running more favoured in the younger age groups (P=0.002).

Many chose to do more than one form of exercise (approximately 50% performed more than one type of exercise and 10% over three types of exercise). The main reasons cited for having a regular exercise program were for maintenance of physical health (77%), mental health (71%) and weight control (35%) (Figure 4).

[FIGURE 3 OMITTED]

For those without an exercise program, the main cited reasons were fatigue (40%), too busy (70%), family commitments (67%) or just not interested (18%) (Figure 5). The only gender differences noted here, were that men were more likely to cite being too busy (76% vs 46%, P=0.005) and women were more likely to have a medical reason for not exercising (11.5% vs 1.7%, P=0.04). Family commitments (P=0.001) and fatigue (P=0.04) were more likely to be cited as reasons for not exercising in the younger age groups.

The thirty specialist anaesthetists recruited from St. Vincent's hospital consisted of both full-time and visiting medical staff. Only 5 of the 30 participants experienced a problem with their pedometers. The main issue appeared to be accidental resetting of the device, and those who had difficulties repeated the exercise. The overall median steps per day for the group was 4770 with a 10th to 90th interpercentile range of 1985 to 8922 and range of 1667 to 9630.

DISCUSSION

To our knowledge, this is the first study that has assessed exercise patterns in anaesthetists. The results are comparable to the general population in Australia in that 58% of anaesthetists exercise regularly (compared with 57% of Australians overall).

[FIGURE 4 OMITTED]

[FIGURE 5 OMITTED]

The presence or absence of an exercise program did not appear to be affected by age, gender or number of working hours and 18% of people without an exercise program were simply 'not interested' in having one.

The number of steps taken per day at work puts anaesthetists in the 'sedentary' category12 (i.e. 42% of anaesthetists are probably not achieving enough physical activity to maintain their health and well-being).

These findings are cause for concern, given that as medical practitioners, our role is to promote health in our patients, and yet our exercise patterns may be no better than that of our patients.

There were several limitations to this investigation. however, the response rate for this mail survey was surprisingly good (61.6%) and we were able to analyse 347 surveys out of a population of 584 anaesthetists, which would result in a sampling error of [+ or -] 3% (13). Furthermore, our data regarding gender, age and hours worked were nearly identical to that from the most recent ANZCA Workforce Survey (ANZCA, personal communication).

Nevertheless, it is possible that the non-respondents had a different exercise pattern to the respondents, e.g. perhaps less active people were less likely to respond. Some of the survey data could not be meaningfully analysed, in particular questions 5, 7 and 8, as they were inconsistently interpreted due to ambiguities in the questions. Potential causes of error and bias from the pedometers are numerous due to intrinsic calibration and sensing mechanism issues. We used pedometers from the same manufacturer, ensured that they were worn consistently, and checked the calibration between participants. On checking, the pedometers generally gave values within 10 to 15% of each other. Despite their limitations, these devices are still useful as a measure of relative activity and as motivational and educational tools.

Given the limited study size of 30 consultants, the results may not reflect the daily work exercise patterns of all anaesthetists. In our sample there were full-time staff members and visiting medical officers, and with this mix we hoped to minimize the bias introduced by variations in different operating theatre configurations and work practices between institutions.

Blinding in this study was attempted in order to limit 'motivation' bias. however, this source of bias may still exist as the participant may have been motivated by the fact that they were wearing a pedometer even though they were counselled so as to minimize this effect. The effect of such a bias would most likely be to increase the step-count rather than decrease it, however all participants failed to reach the 'target' level despite this potential effect.

In summary, this study has shown that a significant number of Victorian anaesthetists (42%) do not achieve adequate physical activity, and has identified some potential reasons. This will hopefully provide motivation and information for the implementation of useful strategies to increase the level of physical activity performed by anaesthetists.

ACKNOWLEDGEMENTS

* St. Vincent's hospital, Melbourne, Department of Anaesthesia

* All participating Consultant Anaesthetists

* Australian and New Zealand College of Anaesthetists

* Patricia Dunnings (Professor of Nursing), St. Vincent's hospital, Melbourne.

* Andy Mark, Regional health Promotion Coordinator, National heart Foundation of Australia (N.S.W. Division)

Accepted for publication on February 24, 2006.

REFERENCES

(1.) Pate RR, Pratt M, Blair SN et al. Physical Activity and Public health. JAMA 1995; 273:402-407.

(2.) American College of Sports Medicine. Position stand: Physical activity, physical fitness, and hypertension. Med Sci Sports Exerc 1993; 25:i-x.

(3.) Bjorntorp P. Visceral Obesity: A "Civilisation Syndrome". Obesity Research 1993; 1:206-222.

(4.) Snow-Harter C, Marcus R. Exercise, Bone Mineral Density, and Osteoporosis. Exerc Sport Sci Rev 1991; 19:351-388.

(5.) King AC, Taylor CB, Haskell WL, DeBusk RF. Influence of regular aerobic exercise on psychological health. health Psychol 1989; 8:305-324.

(6.) DeBusk RF, Stenestrand U, Sheehan M, Haskell WL. Training effects of long versus short bouts of exercise on healthy subjects. Am J Cardiol 1990; 65:1010-1013.

(7.) Ainsworth BE, Haskell WL, leon AS et al. Compendium of physical activities. Med Sci Sports Exerc 1993; 25:71-80.

(8.) Centers for Disease Control and Prevention. US Department of health and human Services. Physical Activity and health: A Report of the Surgeon general Executive Summary, 1996.

(9.) Huddleston S, Mertesdorf J, Araki K. Physical activity behaviour and attitudes toward involvement among physical education, health, and leisure services pre-professional. College Student Journal 2002; Dec:1-13.

(10.) Chan CB, Spangler E, Valcour J, Tudor-Locke C. Cross-sectional Relationship of pedometer-determined ambulatory activity to indicators of health. Obes res 2003; 11:1563-1570.

(11.) Tudor-Locke C, Ainsworth BE, Whitt MC, Thompson RW, Addy CL, Jones DA. The relationship between pedometer-determined ambulatory activity and body composition variables. Int J Obes 2001; 25:1571-1578.

(12.) Tudor-Locke C, Bassett DR. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med 2004; 34:1-8.

(13.) "How to Conduct your own Survey". Salant and Dilman. Wiley 1994.

M. SOH *, R. K. DEAM ([dagger]), R. KLUGER ([double dagger]) St. Vincent's Hospital, Melbourne, Victoria, Australia

* M.B., B.S., Anaesthetic Registrar, Dandenong hospital, Victoria. ([dagger]) M.B., B.S., F.A.N.Z.C.A., M.D., Consultant Anaesthetist, St. Vincent's hospital, Melbourne, Victoria.

([double dagger]) M.B., B.S., F.A.N.Z.C.A., Consultant Anaesthetist, St. Vincent's hospital, Melbourne.

Address for reprints: Dr Roberta Deam, Anaesthetic Department, St. Vincent's hospital, PO Box 2900, Fitzroy 3065, Victoria, Australia.

Questionnaire accessible with full text online at www.aic.net.au
TABLE 1
Demographics--exercisers vs non-exercisers

 Exercise program No program
 (n = 201, 58%) (n = 146, 42%)

Age (y) (median) 47 45
Male / Female (%) 77.5/22.5 82.2/17.8
Full-time/Part-time (%) 72.2/27.8 74.3/25.7
Hours worked/week 46 47
(median)
Smoker (%) 3.5 4.8
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Author:Soh, M.; Deam, R.K.; Kluger, R.
Publication:Anaesthesia and Intensive Care
Date:Jun 1, 2006
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