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Physical activity levels of patients with acute coronary syndrome.

Byline: Saliha Gun Erenay - Email: soguz@marmara.edu.tr

Objectives: Physical activity scales providing international comparisons were developed to assess physical inactivity. The purpose of this study was to investigate the physical activity levels of the patients with acute coronary syndrome (ACS) using International Physical Activity Questionnaire (IPAQ).

Methodology: A total of 110 patients, 26 women and 84 men, who were willing to participate in the study were evaluated. These patients did not have communication problems, had a clear conscious, were aged twenty and above and were currently hospitalized in intensive care unit and diagnosed with ACS.

Results: The mean age of the patients was 59.23+13.20. It was reported that the 65.5% of the patients did not exercise. Physical activity level of men was significantly higher than that of women in the work domain (p=.023), and active transportation domain (p=.006). There was a significant difference between body mass index (BMI) with total IPAQ score (p=.02). There was a significant difference between exercise performance of subjects and the active transportation domain (p=.01) score and between the leisure and the physical activity score (p=.0001).

Conclusion: In Turkey, very few patients with ACS had sufficient level of physical activity which can protect health. Therefore, physical inactivity should be remembered as one of the adjustable major risk factors of ACS and active life style should be promoted.

KEY WORDS: Acute Coronary Syndrome, nursing, physical activity, IPAQ.

How to cite this article:

Erenay SG, Oguz S. Physical activity levels of patients with acute coronary syndrome. Pak J Med Sci 2011;27(1):149-152

INTRODUCTION

Physical inactivity is an independent risk factor for ACS.1,2 According to the WHO, the prevalence of physical inactivity is associated with the 17% of the adult mortality, corresponding to two million.3 As per the results of the National Household Survey in Turkey (2003), 20.32% of people lead sedentary lives and population's activity level of 15.99% is insufficient.4

Physical inactivity is accepted as one of the modifiable major risk factors and changes in thera- peutic life style are described as a key target.5,6 It is estimated that 31.519 deaths due to ischemic heart disease will be prevented provided that sufficient levels of physical activity are achieved.4 According to the Multiple Risk Factor Intervention Trial, a study on ACS, the mortality rate of physically active subjects is 27%, lower than that of physical inactive subjects. On the other hand, intensity, frequency, and type of physical activity are also important.1 Regu- lar physical activity decreases the development risk of ACS, regulates blood pressure, and helps avoid- ing obesity.7,8 The aim of the present study was to determine the levels of physical activity in ACS patients.

METHODOLOGY

The study was carried out at the intensive coro- nary care unit of a heart hospital in Istanbul, Turkey, between June 1st to December 31st 2007 with patients presenting to the intensive coronary care unit dur- ing this seven-month period. The sample included one hundred ten patients with ACS. The inclusion criteria of the study required that the patients should have been diagnosed with ACS, be aged 20 years or above and be conscious.

Data collection and procedure: Data were collected by a questionnaire, developed by the researcher, and the IPAQ, during face-to-face interviews with the patients at the intensive coronary care unit. The va- lidity and reliability of the Turkish version of the IPAQ, which was developed in 1997-1998, was es- tablished by Ozturk.9 In addition, interviews were incorporated in the study by a long-format "the last seven days" instrument.

The questionnaire included socio-demographic information (gender, age, etc.), the variables related with the disease (BMI, exercise status etc.), and also information on the current physical activity. Before the initiation of the study, approval from the ethics committee and the hospital was obtained. The ethics committee of the study center also granted approval for the conduct of the study. The goal of the study was explained to the subjects and the subjects were told that they could choose to withdraw at any time during the study. Patients' questions which might affect the answers about risk factors and physical activity were replied after the interviews.

Data analysis: The statistical analyses were carried out on a computer using SPSS package program, with a statistical significance level of pLess than0.05. Data were presented in percentages and averages. T-test and chi-square test were used to compare non- parametric data.

RESULTS

Subjects had a mean age of 59.23+13.20. Of the subjects, 75.5% were men, 24.5% were women, 78.2% were married. 39.1% were retired (old age pension- ers), 79.1% had mid-class level of income, and 41.8% were primary school graduates. The majority of them (65.5%) did not exercise regularly, and, although 90% of the subjects believed in the benefits of exercise, only 34.5% did exercise. When asked if exercising had beneficial effects on cardiac health, 77% of the subjects responded affirmatively. Subjects had a mean BMI of 26.83+-3.52 kg/m2; 47.3% of them were overweight, 19.1% were obese (Table-I).

A difference was noted between gender and work- related physical activity (p=0.023). Men were found to be more active than women. IPAQ demonstrated significantly higher physical activity levels for males compared to females in transportation (p=0.006). However, there were no differences between gen- ders with respect to domestic physical activity and gardening (p=.339) and leisure time physical activ- ity (p=0.186). Another significant difference was noted between gender and IPAQ total score (p=0.024) (Table-II).

The Fisher kh 2 revealed a statistically significant difference between BMI and IPAQ total scores (p=0.02), with decreasing levels of exercise with increasing BMIs. It was concluded that obese subjects and those with higher BMIs had insufficient levels of physical activity (Table-III).

When physical activity levels of subjects and IPAQ sub-domains were analyzed, no difference was noted between work-related physical activity, domestic physical activity and gardening and IPAQ total score. There was, however, a significant difference between transport-related physical activity (p=.01) and leisure-time domain physical activity (p=.0001). As expected, physically active subjects were also more active in leisure times (Table-IV).

DISCUSSION

The result of the present study demonstrated that most of the subjects were inactive, with 65.5% not being involved in any physical activity. A study by Savci et al. examining the physical activity levels of university students of healthcare-related depart- ments in Turkey, also reported that 87% of these patients had physical activity levels below the required level to maintain and improve health, similar to the findings of the present study.10

In the present study, 47.3% of subjects were obese. In a study by Weinstein et al. on the effects of BMI and physical activity on cardiovascular diseases in women, the incidence of cardiovascular diseases was significantly higher in women who had higher BMI values.11 According to the authors, both higher BMIs and physical inactivity were individual predictors of ACS. We believe that risk factors can be signifi- cantly eliminated by increasing the physical activity levels, decreasing the weight and BMI of the individuals.

A significant difference was noted between gender and work-related physical activity and be- tween gender and transport-related physical activ- ity. Although there was no difference between gen- ders with respect to domestic physical activity and gardening, and with respect to leisure time physical activity, a significant difference was noted between IPAQ total score and gender. Men were found to be more active than women.

Having compared the physical activity levels of university students, Savci et al10 reported higher levels of physical activity in male compared to female university students. In a study by Muntner et al. regarding the physical activity of Chinese adults living in urban and rural areas, young males were found to be more active than females and old males at work-related physical activity, leisure time physi- cal activity and total physical activity scores.12 In an- other study from Norway by Graff-Iversen et al. com- paring physical activity levels of people from differ- ent ethnic groups with similarly low-levels of income, males were found to maintain a higher level of physical activity at all physical activity domains, in- cluding higher leisure time physical activity and work-related physical activity.13

According to a study by Onat on the role of physi- cal activity in protection against metabolic disorders and coronary mortality, males had higher levels of physical activity compared to women.8

In our study, males were found to have higher work-related physical activity and total IPAQ score similar to the studies by Muntner and Graff-Iversen. The studies by Onat and Savci also reported high physical activity levels in men compared to women. In patients with ACS, declining levels of activity in domestic and gardening sub-domains were noted with increasing age and a comparison of physical activity levels and age groups yielded significantly decreased levels of activity in elder individuals. A study by Kaphingst et al. similarly reported decreased levels of activity with increasing age.14

Physical activity was inversely associated with age in Kaphingst's study. Examining the levels of physi- cal activity of adolescents for four years, Adams also reported significant decreases in physical activity with increasing ages.15

The results of the present study showed a decrease in activity in domestic and gardening sub-domains with increasing age. Overall, physical activity declines with increasing age. The findings of the present study are consistent with the studies mentioned above. The data from the present study underlines the importance of being physically active for a healthy life and indicates that the incidence of physical inactivity in individuals is still on the rise.

CONCLUSION

In Turkey, most of the patients with ACS are physically inactive and the levels of physical inac- tivity in individuals are even poorer among women compared to men. Besides, levels of physical activ- ity also decline with increasing age. Individual dif- ferences, gender and age should, therefore, be con- sidered when planning exercise programs to prevent ACS. It should be noted that physical inactivity is a risk factor for ACS, which is modifiable through therapeutic life style changes. Hence, it should be aimed to encourage active life styles among individu- als with this condition.

Table-I: Distribution of the subjects' socio-demographic and clinical characteristic (N=110).

Parameters

Age (Mean + SD)###59.23+13.20 (Range=28-87)

BMI (Mean + SD)###26.83+ 3.52 (Range=19.84-36.85)

Gender###Female###27###24.5

###Male###83###75.5

Profession###Manager Employee###13###11.8

###Self-employed###4###3.6

###Retired, jobless###29###26.4

###Housewife###43###39.1

Marital Status###Married###86###78.2

###Single###24###21.8

Educational###Illiterate###10###9.1

Background###Literate###9###8.2

###Primary School###46###41.8

###Secondary School###18###16.4

###High School###19###17.3

###College###8###7.2

Economic###Upper level###14###12.7

Condition###Mid-level###87###79.1

###Lower level###9###8.2

Doing Exercise###Doing exercise###38###34.5

###Not doing exercise###72###65.5

Believe in###Believing###99###90

the benefits###Not believing###3###2.7

of exercise###Having no idea###8###7.3

Given an###Yes###29###26.4

exercise program No###81###73.6

BMI###Normal weight (18.6-25) 37###33.6

###Over weight (25.1-30)###52###47.3

###Obesity (30.1 - 40)###21###19.1

Smoking###Smoker###52###47.3

###Non-smoker###37###33.6

###Quit-smoker###21###19.1

Taking Alcohol###Yes###52###19.1

###No###37###71.9

###Quit Alcohol Use###21###9

Table-II: Difference between gender and IPAQ sub-scales by the IPAQ classification (N=110).

Domains of the IPAQ###Gender###n###Mean###SD###t###p

Work Domain###Female###27###1.0741 0.26688###-2.304###0.023

###Male###83###1.4217 0.76701

Active Transportation Domain###Female###27###1.0370 0.19245###-2.777###0.006

###Male###83###1.3494 0.57241

Domestic and Garden (Yard Work) Domain###Female###27###1.2963 0.54171###0.960###0.339

###Male###83###1.1807 0.54425

Leisure-Time Domain###Female###27###1.0741 0.26688###-1.330###0.186

###Male###83###1.1807 0.38713

Total Physical Activity Category###Female###27###1.4074 0.63605###-2.296###0.024

###Male###83###1.8193 0.85746

Table-III: The difference between subjects' BMIs and IPAQ total scores (N=110).

BMI###Total Physical Activity Scores (n)###kh2###p

###1 (Low)###2 (Moderate)###3 (High)###Total###11.67 .02

2 (18.6 - 25)###21 (19.2)###9 (9.1)###7 (8.7)###37 (37.0)###

3 (25.1 - 30)###20 (26.9)###17 (12.8)###15 (12.3)###52 (52.0)###

4 (30.1 - 40)###16 (10.9)###1 (5.2)###4 (5.0)###21 (21.0)

Table-IV: The difference between exercise status and scores from IPAQ sub-domains (N=110).

Domains of the IPAQ###Exercise Status###n###Mean###SD###t###p

Work Domain###Yes###38###1838.82 8029.90###0.8.8###0.421

###No###72###1010.37 2489.90

Active Transportation Domain###Yes###38###777.82###1324.21###2.637###0.01

###No###72###319.46###478.38

Domestic and Garden (Yard Work) Domain###Yes###38###1007.57 3384.45###0.998###0.321

###No###72###544.45###1476.02

Leisure-Time Domain###Yes###38###546.65###596.87###4.635 0.0001

###No###72###125.27###356.48

Total Physical Activity Category###Yes###38###4170.84 8630.58###1.881###0.63

###No###72###1996.81 3426.46

REFERENCES

1. Alpert SJ, Rippe MJ. Exercises and cardiovascular system. Ongen Z (Ed), Diagnose and Treatment Handbook of Car diovascular Diseases. European Medicine Books Publishing, Istanbul. 2003:147-159.

2. Enar R. Guide of Cardiovascular Health. 1. Ed., Servier Medicine Publishing, Istanbul. 2007: 333-341.

3. Physical activity. World Health Organization. Available at:http://www.who.int/dietphysicalactivity/publications/facts/pa/en/index.html. Assessed on August 3, 2010.

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9. Ozturk M. Validity and reliability of IPAQ-L and determine to physical activity levels of university students. University of Hacettepe, Institute of Health Sciences. Master of Science Thesis, Ankara, 2005.

10. Savci S, Ozturk M, Arikan H, Inal ID, Tokgozoglu L. Physical activity levels of university students. Turk Kardiyol Dern Ars 2006;34(3):166-172.

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12. Muntner P, Gu D, Wildman RP, Jichun CJ, Qan W, Paul K, et al. Prevalence of Physical Activity Among Chinese Adults: Results From the International Collaborative Study of Car- diovascular Disease in Asia. Am J Public Health 2005;95(9):1631-1636.

13. Graff-Iversen S, Anderssen SA, Holme IM. An adapted version of the long international physical activity questionnaire (IPAQ-L): Construct validity in a low-income, multiethnic population study from Oslo, Norway. Int J Behav Nutr Phys Act 2007;4:13.

14. Kaphingst KA, Bennett GG, Sorensen G, Kaphingst KM, O'Neil AE, McInnis K. Body mass index, physical activity, and dietary behaviors among members of an urban community fitness center: A questionnaire survey. BMC Public Health 2007;7:181.

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Author:Erenay, Saliha Gun
Publication:Pakistan Journal of Medical Sciences
Article Type:Clinical report
Geographic Code:7TURK
Date:Mar 31, 2011
Words:2712
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