|Year : 2015 | Volume
| Issue : 3 | Page : 229-233
Obesity, physical inactivity, and cardiorespiratory fitness of high school students in Urban Ludhiana, North West India: A survey
Daisy A David, Clarence J Samuel
Department of Community Medicine, Christian Medical College, Ludhiana, Punjab, India
|Date of Web Publication||12-Jun-2015|
Clarence J Samuel
Department of Community Medicine, Christian Medical College, Ludhiana - 141 008, Punjab
Source of Support: None, Conflict of Interest: None
Context: The level of cardiorespiratory fitness (CRF) among the early adolescent would provide a measure of future burden of cardiovascular disease in Ludhiana, North West India. Aims: The aim was to estimate the level of CRF with the help of multi-stage-fitness (Bleep) test in high school students. Settings and Design: Cross sectional study in urban Ludhiana. Subjects and Methods: Totally, 200 school children were selected by simple random sampling from four schools. After the consent, a pretested questionnaire was administered, and the Bleep test performed. Statistical Analysis Used: Frequencies and proportions were calculated, Chi-square and t-test were the tests of significance. Results: The prevalence of obesity was 2.5%, overweight, severe thinness, and thin was15.5%, 1.5%, and 5%, respectively. There were more extreme weights among boys compared to girls (Chi-square = 7.59 and P = 0.022). The mean hours of weekly vigorous sports activity was 2.14 ± 0.63. The mean maximum aerobic capacity was 26.80 ± 4.37. CRF scores of very poor in 72.0% with only 7.05% scoring as Fair. More boys (93.8%) had very poor CRF scores compared to girls (43.7%). Score of Fair CRF in 16.0% girls and 0.9% boy. Conclusions: The high school children in urban Ludhiana, Northwest India exhibit high levels of physical inactivity, worsening obesity, and low levels of CRF, boys are more affected compared to girls. The bleep test is a low-cost and feasible quantitative tool to measure cardio respiratory fitness in limited resource setting.
Keywords: Adolescent, cardiorespiratory fitness, high school children, multi-stage fitness
|How to cite this article:|
David DA, Samuel CJ. Obesity, physical inactivity, and cardiorespiratory fitness of high school students in Urban Ludhiana, North West India: A survey. CHRISMED J Health Res 2015;2:229-33
|How to cite this URL:|
David DA, Samuel CJ. Obesity, physical inactivity, and cardiorespiratory fitness of high school students in Urban Ludhiana, North West India: A survey. CHRISMED J Health Res [serial online] 2015 [cited 2020 Jan 24];2:229-33. Available from: http://www.cjhr.org/text.asp?2015/2/3/229/158687
| Introduction|| |
Cardiovascular diseases (CVD) have now become the leading contributor of mortality in India. , Numerous studies have shown that physical inactivity and poor cardiorespiratory fitness (CRF) are associated with mortality and morbidity from CVD. ,,,,
Some risk factors such as western diet, physical inactivity, obesity which causes high blood pressure, diabetes, and lipid abnormalities are identified to be the major predisposing factors, making India the highest country with loss in productive years of life. ,
Cardiorespiratory fitness refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. CRF is the interaction between the heart and the lungs in determining overall fitness. ,,
Few studies have been conducted in India that assess the physical activity and obesity in school children and their relation to CRF.
| Subjects and methods|| |
This cross-sectional study was conducted in the city of Ludhiana, Punjab, North Western India. Ludhiana is known for its textiles, machine tools, automobiles, etc., and is the commercial capital of Punjab. It has a population of 1,613,878 inhabitants and a human development index of 0.537. The sample frame consisted of school children studying in the private school system up to 10 th grade.
The bleep test was pilot tested in 5 individuals of similar demography who were not from the selected schools and all scored as fair CRF. Studies have shown that 20% school children are overweight who then we assumed would have a low CRF. We further assumed that an additional 10% of the normal weight children would also have a low CRF making and estimated prevalence of low CRF to be 30%. The following parameters were used to estimate sample size: An error of 20%, an estimated prevalence of low CRF of 30% and a confidence interval of 95%. All schools in Ludhiana city with 10 th grade (class) were listed and selection of the schools, grades (class) and divisions (sections) were done using a table of random numbers. School administrator's approval was sought for the schools participation. All children in the division meeting the inclusion criteria, after a written parental consent and student's written assent, were included in the study. Data collection took place between April 2012 and July 2012.
All participants completed a physical activity questionnaire. Height weight and CRF were measured in all subjects. Exclusion criteria were those with physical impairments or disabilities, medical conditions such as cardiovascular disease, bronchial asthma.
Written informed consent was obtained from the parent or legal guardian of the school children after being given a detailed written explanation of the aims of the study, and the possible hazards, discomfort, and inconvenience. The students further gave written assent and were given the option to drop out at any time without consequence. This research was approved by the Institutional Ethics Committee
| Anthropometric measurement|| |
Physical measurements were recorded by the student investigator. Wearing light clothing weights were recorded to the nearest 0.25 kg using a bathroom scale which was calibration using standard weights. Height was recorded on a fixed stadiometer to the nearest 0.1 cm making the participant stand upright looking forward on a level surface without shoes keeping the heels together and toes apart. Body mass index (BMI) for age was calculated and classified as per the World Health Organization (WHO) 2003 standards for 5-19 years olds.  BMI for age < −3 standard deviations (SD) was classified as severe thinness, thinness: < −2 SD overweight: > +1 SD, obesity: > +2 SD and normal < +1 SD to > −2 SD. 
Cardio respiratory fitness
Leger et al. first used 20-m shuttle run test to estimate CRF in 1982.  The bleep test was carried out on the school playgrounds. The required speed was continuously increased every minute by 0.5 km/h. Subjects kept the required speed by completing every 20-m stage within the sound of two beeping sounds using a prerecorded file on an MP3 player and a whistle. The interval between these beeps was reduced every minute in order to elicit the speed increments. The velocity in the last stage completed by each subject was recorded and used to calculate the maximum aerobic capacity (VO 2 max), by age and gender. The bleep test is a universally accepted as having been validated for VO 2 Max against standard multistage treadmill testing (r = 0.90).  Numerous studies around the world have demonstrated a test-retest reliability coefficients of 0.89 for children and 0.95 for adults and its use for large-scale fitness assessment. ,
Definitions for television viewing, physical activity
Standards for television (TV) viewing are based on recommendation of the American Academy of Pediatrics that more than 2 h TV viewing/computer games per day (14 h/week) is to be considered as excessive. 
The WHO's global standard for physical activity requires that children indulge in at least 60 min or 1 h of moderate to vigorous physical activity per day, this is equal to 7 h/week. We grouped those accumulated the recommended amount of activity per week ≥ 7 h/week, those less than the recommended (1-<7 h/week) and none at all. 
Frequencies and proportions were calculated, Chi-square was the measure of association with significance at 0.05 using SPSS 16 version.
| Results|| |
Descriptive data by gender are shown in [Table 1]. Of the 200 high school students, 56.5% were males. The majority of participants (72.0%) claimed to have took part in vigorous physical activity for more than 1 h/day (7 days a week) while only 13.5% (27) indulged in-vigorous physical activity < 1 h/week. The mean hours of play per week was mean ± SD (2.14 ± 0.629 h).
[Table 2] shows the BMI for age categories as per the WHO standards by gender in which boys exhibited a larger proportion with malnutrition (under-nutrition and over-nutrition) (Chi-square = 7.59 P = 0.022). The prevalence of under-nutrition was 6.5% and over nutrition was 18%.
|Table 2: Anthropometric, cardiorespiratory fitness and physical activity characteristics of urban Ludhiana school children by gender |
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[Table 3] shows the BMI for age categories as per the WHO Standards by the total hours of physical activity per week, with 72% playing less than the required 1 h/day and 18.5% not playing at all [Table 4]. The amount of physical activity was not associated with obesity Chi-square = 0.69 P = 0.71. Among the obese, 80% played <1 h/day or 7 h/week, while among the overweight, 64.4% played < 7 h/week.
|Table 3: Comparison of the BMI for age as per WHO growth charts by gender |
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|Table 4: Distribution of BMI for age as per WHO growth charts by total hours of play per week |
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The prevalence of CRF by hours indulged in leisure activities per week is shown in [Figure 1] and [Table 5]. Higher prevalence of obesity and low CRF was observed in more inactive school children, [Table 6] the boys were more affected compared to girls as shown in [Table 7].
|Table 5: Cardiorespiratory fitness by television viewing/computer habits per week |
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|Figure 2: The mean and standard deviation of maximum aerobic capacity by body mass index for age categories and gender|
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[Figure 2] shows the CRF worsens with increasing BMI category. Those with lower BMI have higher mean VO 2 Max Chi-square = 2.09 P = 0.98
| Discussion|| |
The CRF was classified a very poor CRF and poor CRF in the majority of the students; this is probably due to lack of fitness rather than because of a difference in the physique of Indian students. The multi-stage fitness test has been used to assess improvement of antimalarials as children can affected by medical conditions such as anemia, malnutrition, and other nutritional deficiency disorders as per studies in Africa. 
In our study, 75% of the students with normal BMI, low BMI (thin or severely thin) 6.5%, and higher BMI's overweight 15% and 2.5% obese. This is similar to another study done on adolescent of Ludhiana catering to the affluent segment of population shows that the overall incidence of obesity in the study group was 3.4%, with no significant difference between boys and girls. Significantly, a greater number of boys (15%) as compared to girls (10.2%) were overweight. In another study done in urban South India, 17.8% of boys and 15.8% of girls aged 13-18 years were overweight or obese.  Overweight is comparable to similar studies in India. ,
A study in USA showed that in 2004-2007 grade for physical education were 88% of 8 th graders, 48% of 10 th graders, and 20% of 12 th graders, showing an emphasis on the academic pursuits rather than on the health and fitness. 
Viner and Cole's study revealed that 40% of the participants exceeded the American Academy of Pediatrics's guidelines of <1 h/day of TV, they postulated that each additional hour of weekend TV watching may increase the risk of obesity in 30-year-olds by 7%. 
In a study done by CDC in the USA among adolescents, they found that boys and girls were approximately 20-25% less likely to be classified as overweight if they reported 2-3 h of TV per day and approximately 40% less likely to be classified as overweight if they reported ≤1 h of TV per day compared with those who watched ≥4 h of TV. ,
Our study shows that the proportion of those that watched excessive TV were less likely to participate in any sport or physical activity, but there was no significant association between excessive TV viewing and the student being overweight or having lower CRF [Table 5].
Another study showed that children with low CRF characteristically had a higher waist circumference, disproportionate weight gain, overweight classification was 3.5-fold higher in youth with low CRF, and CRF were significantly and independently associated with increasing BMI. 
The link between physical activity and CRF as strong indicators of future coronary artery disease and metabolic syndrome has shown that the roots of these problems lie in adolescence.
Our study shows that CRF can be assessed using the multistage fitness test among high school children in urban Ludhiana, North-Western India. The CRF is satisfactory in only 21% of school children. We suggest that the CRF can be improved by training teachers how to conduct the multi-stage fitness test and by introducing graded physical activity exercise routines for school students during the week. We suggest that the number of hours of moderate-vigorous play and sports at home needs to be increased by exchanging physical activity with sedentary leisure activities, furthermore with the need to provide secure playing spaces and playing time. The hours of physical education/games need to be increased at schools, and a physical education grade should be included in the Annual Exams and the External (Board) Exams.
The primary limitation of this cross-sectional study is that temporal association could not be proved between the risk factors. Another limitation is the use of a self-reported physical activity questionnaire. This study did not evaluate the influence and prevalence of anemia on cardiorespiratory fitness. 
Positive habits inculcated in childhood would help in a reduction of the obesogenic lifestyle and would prevent CAD, stroke, and other conditions during adulthood. The multi-stage fitness test is a good measure for CRF and should be universally adopted as a quantitative measure of fitness among Indian school children. Further research is required to assess if the present VO 2 max cut-off of need to be adjusted for Indian children, the optimal amount of physical activity needed to maximize health benefits and evaluate the influence of anemia on CRF.
| Conclusion|| |
In summary, our study demonstrates that there is a high prevalence of obesity, poor CRF , and physical inactivity among urban high school students in North West India. The multi-stage fitness test is a good measure of CRF and can be universally adopted as a quantitative measure of fitness among school children in India.
| Acknowledgment|| |
The principals, students, and the physical education teachers of the four schools who want to keep the schools anonymous. ICMR STS Grant 2011.
| References|| |
Lopez AD. Assessing the burden of mortality from cardiovascular diseases. World Health Stat Q 1993;46:91-6.
Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998;97:596-601.
McGavock JM, Torrance BD, McGuire KA, Wozny PD, Lewanczuk RZ. fitness and the risk of overweight in youth: The Healthy Hearts Longitudinal Study of Cardiometabolic Health. Obesity (Silver Spring) 2009;17:1802-7.
Artero EG, Jackson AS, Sui X, Lee DC, O'Connor DP, Lavie CJ, et al
. Longitudinal algorithms to estimate cardiorespiratory fitness: Associations with nonfatal cardiovascular disease and disease-specific mortality. J Am Coll Cardiol 2014;63:2289-96.
Timpka S, Petersson IF, Zhou C, Englund M. Muscle strength in adolescent men and risk of cardiovascular disease events and mortality in middle age: A prospective cohort study. BMC Med 2014;12:62.
Nes BM, Vatten LJ, Nauman J, Janszky I, Wisløff U. A simple nonexercise model of cardiorespiratory fitness predicts long-term mortality. Med Sci Sports Exerc 2014;46:1159-65.
Cuenca-García M, Artero EG, Sui X, Lee DC, Hebert JR, Blair SN. Dietary indices, cardiovascular risk factors and mortality in middle-aged adults: Findings from the Aerobics Center Longitudinal Study. Ann Epidemiol 2014;24:297-303.e2.
Harris J, Cale L. A review of children's fitness testing. Eur Phys Educ Rev 2006;12:201-25.
Clark E. The Validity, Reliability and Physiological Foundations of a VO 2
max Test Versus a Predictive Maximal Oxygen Uptake Test. Emily Clark. Available from: http://www.emilymayclark.wordpress.com/2012/01/30/the-validity-reliability-and-physiological-foundations-of-a-vo2 max-test-versus-a-predictive-maximal-oxygen-uptake-test/. [Last cited on 2014 Oct 07].
WHO | BMI-for-age (5-19 years). WHO. Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/. [Last cited on 2014 Oct 07].
Léger LA, Mercier D, Gadoury C, Lambert J. The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci 1988;6:93-101.
American Academy of Pediatrics. Committee on Public Education. American Academy of Pediatrics: Children, adolescents, and television. Pediatrics 2001;107:423-6.
WHO | Physical Activity and Young People. WHO. Available from: http://www.who.int/dietphysicalactivity/factsheet_young_people/en/. [Last cited on 2014 Oct 07].
Bustinduy AL, Thomas CL, Fiutem JJ, Parraga IM, Mungai PL, Muchiri EM, et al.
Measuring fitness of Kenyan children with polyparasitic infections using the 20-meter shuttle run test as a morbidity metric. PLoS Negl Trop Dis 2011;5:e1213.
Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L, et al.
Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002;57:185-90.
John EM, Samuel CJ. Heart health risk factors in Punjabi early teens. CHRISMED J Health Res 2014;1:25-9.
Viner RM, Cole TJ. Television viewing in early childhood predicts adult body mass index. J Pediatr 2005;147:429-35.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]