The prevalence of physical activity among MBBS students in a medical college in Kerala

Background: The healthy lifestyle of medical students could facilitate the formation of healthy physicians who is more likely to give effective preventive counseling to their patients. Therefore, there is compelling evidence that the health of doctors matters, and the doctors’ own physical activity practices influence their clinical attitudes towards physical activity. Aim and objectives: To assess the prevalence of physical activity and its determinants and also to find out the barriers of physical activity among MBBS students in a medical college in Kerala. Methods: A cross-sectional study was conducted amongst 180 undergraduate medical students. Data was obtained from students using the Global Physical Activity Questionnaire (GPAQ) by WHO and Metabolic Equivalents (METs) were used to express the intensity of physical activities. Results: Of the total 180 students, 128 (71.1%) were found as physically active, and 52 (28.9%) as physically inactive. Among the physically active students, 98 (54.44%) and 30 (16.66%) showed moderate and high levels of physical activity respectively. The mean MET minutes per week attained by the study population in recreational activities is more compared to work and transport. Conclusion: Of the 180 students, average MET scores attained by males and females in the 3 domains of physical activity showed significant difference highlighting the need to promote more activities among females.


Introduction
The world population is aging, while increased development has been accompanied by rising disposable incomes, urbanization, mechanization, and the globalization of food markets, leading to lifestyle and behavior changes that adversely impact population health. These lifestyle changes include dietary changes (nutrition transition), reduced physical activity levels, and increased tobacco use.
The result is that non-communicable diseases are increasing at alarming rates globally. The burden of non-communicable diseases in developing countries already outweighs that of communicable diseases, both in high-and low-income countries [1].
Physical activity is defined as any bodily movement produced by skeletal muscles that result in energy expenditure. The energy expenditure can be measured in kilocalories. Physical  Medical schools need to increase the proportion of students adopting and maintaining regular physical activity habits to increase the rates and quality of future physical activity counseling delivered by doctors [10].
Hence it becomes a matter of paramount importance to find out the prevalence of physical activity among MBBS students.

Materials and Methods
A cross-sectional study was conducted amongst undergraduate medical students in a medical college in Thrissur, Kerala from July 2019 to October 2019.

Discussion
Of students did not meet the WHO recommended MET minutes/week, 43.2% of students showed moderate and 41.3% showed high levels of physical activity [11]. The percentage of students with low physical activity is much higher in the current study whereas the percentage of students with a high level of physical activity is lower compared to the study conducted in Bangalore. In the present study more than half of the students were engaged in moderate physical activity. In contrast, the study conducted in Bangalore revealed that the percentage of students engaged in moderate and high physical activity was almost the same.
The main source of physical activity energy expenditure in the present study was from recreational activities and least was from transport.
In the study conducted in Bangalore, most of the students were engaged in work-related activities rather than transport and recreation. From the present study it was evident that in spite of the busy curriculum, the students were spending their time doing more recreational activities. This could be due to the presence of many physical activity programs and recreational facilities. Transport contributing least to the attainment of physical activity levels could be due to the fact that most of the students were hostellers and most of their requirements were met from their surroundings itself. Another study showed that the main contributors to total physical activity among adults were from working and active commuting. The leisure-time physical activity represented a very small proportion (9.4%) of individuals' total activity levels [12].
One significant finding of the study is the difference between male and female students with respect to Asian women [13].
In the present study, of the 19 students enrolled in the gym, 18  Arabia [14]. In contrast, a positive correlation was observed between degrees of parents' education and levels of physical activity in a study among female university students [19].
A study conducted among Egyptian and Saudi medical students showed that the most frequent barriers to physical activity were time limitation due to busy study schedules and lack of accessible and suitable sporting places [20] which did not come as a barrier in the present study. Many students in the present study considered that their parents giving priority to academics over physical activity as a barrier to doing exercise.
In the current study, more than half of the students Questionnaire). This suggests that most adults in these countries are obtaining some activity, yet the global problem of the rising prevalence of obesity remains. Thus, it appears total physical activity In most countries remains insufficient to ensure energy balance and prevent obesity [21] or that the ratio of energy expenditure to dietary intake is unbalanced to maintain weight stability [22].

Strengths:
The study topic has huge relevance in the context of non-communicable diseases. Also, the study was conducted using the WHO GPAQ questionnaire and it makes a comparison of results possible.

Limitations
The study was conducted among MBBS students in a medical college in Kerala. The results of the study may not generalizable to the general population.

Conclusion
Of the total 180 students, 52(28.89%) students did not achieve the WHO recommended MET minutes per week. 98(54.44%) students were engaged in a moderate level of physical activity and 30(16.66%) achieved a high level of physical activity. Of the total 52 students who did not achieve the recommended MET scores, only 9 were males and the rest were females. Average MET scores attained by males and females in the 3 domains of physical activity showed significant difference highlighting the need to promote more activities among females.
Mean MET minutes per week attained by students in recreational activities were more compared to work and transport-related activities.
Those who enrolled in the health club were more physically active than others pointing to the fact that the incorporation of physical activity to the daily routine may be easy on an institutional and social platform.
Age, Body Mass Index (BMI), residence, schooling, religion, and educational status of parents were not determinants of physical activity.
What does the study add to the existing knowledge Of the total students, 71.1% were of the opinion that other recreational activities with their friends were more entertaining than exercising. 60% of students agreed that their parents gave priority to academics over physical activity and more than half were of the opinion that exercise did not have Convenient schedules for them. The majority of the students felt that exercise gave them a sense of personal accomplishment and decreased feelings of stress and tension for them.
Colleges and universities should ensure a safe and conducive environment is available on college campuses for students to engage in physical activities. Health clubs and gyms should be run by the educational institution and student participation must be ensured. Promote different activities that help to integrate physical activity into routine life.
Author's contribution