Background: Physical inactivity is becoming an epidemic, causing a slew of illnesses. A healthy service provider can play a good modelling role in preaching exercise and its importance to needy individuals in their practice. Therefore, this study was carried out in Gujarat, India, among undergraduate or postgraduate physiotherapy students to understand the ground level facts regarding the knowledge, attitude, and practice of exercise.
Methodology: A survey research was conducted using Google forms from January 2021 to March 2021. A total number of 303 participants were included from 72 colleges. Participants were asked to complete a validated knowledge, attitude, and practice (KAP) questionnaire via online survey.
Results: In the present study, the study participants agreed that exercise improves their health and fitness levels, and the causes responsible for not completing regular exercise at intervals were found to be job load, lack of partner for exercise, tiredness, or lack of enthusiasm. Participants who did not frequently exercise thought that exercise was demanding and caused strain and tiredness. It was also observed that aerobics and yoga, walking, and strength training were chosen as favourite routine exercises.
Conclusion: Physiotherapy students were fully aware of the advantages and drawbacks of exercise. In general, they chose to exercise at home while self-monitoring.
Exercise is a kind of physical activity performed by skeletal muscle action that results in energy expenditure maintaining the body physical fitness. Physical activity recommendations have been developed to advise individuals about the minimal amount of physical activity required to enhance health. As per literature, the risks for mortality, obesity and diabetes have been reduced or prevented by physical activity.1-3 Sedentary lifestyle is thought to be responsible for one-third of all fatalities including coronary heart disease, colon cancer, and type 2 diabetes.4 Physical inactivity is therefore a significant component in the genesis and development of chronic illnesses such as cardiovascular and metabolic disorders, which are prevalent, burdensome, and expensive. The recommendations: “Physical Activity Guidelines for Americans” introduced in 2008 (Physical Activity Guidelines for Americans, 2008) and “Global Recommendations on Physical Activity and Health” from WHO introduced in 2010 (Global Recommendations on Physical Activity for Health, WHO 2010) stated that minimum recommendation for physical activity in adults is aerobic activity either 2 hours 30 minutes per day moderate-intensity or 1 hours 15 minutes per day vigorous-intensity.5,6 Exercising can encompass a variety of activities such as gardening, vehicle washing, or strolling around the neighbourhood with a pet, and it can even be done at home.7
In the above context, this research was carried out to study the knowledge, attitude, and practice of exercise among physiotherapy students. In general, the research was done aiming to know the awareness levels, perspectives and personal practice limitations or barriers of the students towards physical activity and its importance. A healthy service provider can play a good modelling role in preaching exercise and its importance to needy individuals in their practice. So, understanding the ground level facts regarding the knowledge, attitude, and practice of exercise among physiotherapy students may be, very much, a substantial feedback in that terms.
Materials and Methods
A survey research was conducted using Google forms from January 2021 to March 2021. A total number of 303 undergraduate and postgraduate physiotherapy students participated in the study. The students of physiotherapy colleges in the state of Gujarat were asked to complete a self-made structured questionnaire after obtaining their consent to participate in this study. The questionnaire was developed according to the findings of previous study and has been reviewed and validated by the supervisor of research.8
The questionnaire was divided into four sections which included questions regarding personal demographic data, knowledge, attitude, and practice regarding exercise. The knowledge and attitude about exercise were evaluated using a Likert response scale ranging from 1 to 5 (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree). The practice of exercise was evaluated with questions on the frequency, duration, location, intensity, monitoring, and purpose of exercising. Student “t” test was done to determine the gender difference in performing regular exercise and the differences in knowledge, attitude, and practice of exercise between the regular exercise performers and non-performers. The analysis of the data was done using IBM SPSS statistics for windows, version 20.0. (Armonk, NY: IBM Corp.) and the statistical significance was set at p <0.05.
The survey forms were distributed in all the physiotherapy institutions in Gujarat (72 colleges). A total of 303 responses were received, with women outnumbering men by 251 (83%) to 52 (17%). Among them, 56% were 4th year B.P.T. students and interns, 13% were 3rd year B.P.T students, 16% were 1st and 2nd year B.P.T students, and 15% were 1st and 2nd year M.P.T students.
Regarding the benefits of exercising, around 252 participants agreed that exercise improves health, whereas 14 participants disagreed with this assertion. However, 37 people were not sure if exercise is beneficial or not. Majority of the participants (251) believed that exercise increases strength and flexibility while only 15 did not agree that exercise increases strength and flexibility. Around 219 participants stated that activity can relieve stress. However, 63 people responded neutrally to this assertion, which was threefold to the participants who disagreed (Figure 1 & 2).
Majority of the participants were found to exercise to improve their fitness (132) and health (122), while 95 and 64 participants stated that they exercised to manage their weight and look nice, respectively. The remaining participants exercised for a variety of reasons, such as enjoyment (25), weight gain, treatment of musculoskeletal illness, and so on. Participants’ main reasons for not exercising are lack of time (101), boredom (92) and a heavy workload (92). More than half of the participants did not exercise because they did not have a partner (35) or because they did not have energy and were fatigued (21). Other reasons for not exercising included lack of time, lack of interest, and lack of motivation (Figure 3 & 4).
Over half of the population, 166 (54.90%), exercised on a regular basis, while the remaining 137 (45.10 %) did not. Regarding the participants’ levels of intensity, around 77.8% were doing moderate-intensity exercise, whereas 12% were doing low-intensity exercise. The remaining individuals (10.20%) were engaged in highintensity exercise. Around 40.1% of the participants exercised for more than 30 minutes, 27.5% exercised for 20-25 minutes, 19.2% exercised for 15-20 minutes, and 4.2% exercised for 10-15 minutes. It was also observed that 9% of the participants exercised more than three times per week, 23.4% exercised three times per week, and 67.7% exercised twice per week (Figure 5, 6 & 7). Majority of the respondents were doing aerobics and yoga (137), followed by walking (113), and strengthening exercises (107). However, the remaining individuals reported performing exercise in the form of running (55), cycling and swimming (49), and others (3). Our research participants generally exercised at home (124) rather at gym, garden, and any another location. Over a tenth of the study population was exercising under the supervision of a professional. In contrast, more than half of the population favoured self-monitoring exercise.
Knowledge, attitude, and practice regarding exercise
According to Table 1, there was no significant gender difference in regular exercise. Table 2 depicts the differences in knowledge and attitude between individuals who exercise frequently and those who do not.
The current study seeks to explore knowledge and attitude of physiotherapy students towards exercise practice. According to the present study, more than half of the participants recognised what exercise was and the majority were aware of the benefits of exercise, such as improvement in health, strength, flexibility, stress relief, and how it helps to battle various diseases, and makes life more enjoyable. Participants who did not frequently exercise thought that exercise can be stressful and causes strain and tiredness. This in line with earlier study that found the diaphragm and abdominal muscles to be vulnerable to fatigue after severe prolonged activity.9 Regular exercise can help manage blood glucose levels and postpone the onset of many chronic illnesses, including type 2 diabetes and cardiovascular disease.10,11 Regular exercise lowers the miseries of people suffering from anxiety neurosis, improves their mood, and creates a sense of satisfaction.12 Participants in the current study also believed that exercise improves endurance and stamina.13 Furthermore, majority of the participants believed that exercise is not a stressful activity and makes them happy.14 However, majority of the participants in this study had positive knowledge about loss of vitamins and iron after performing exercise.
Exercise, according to research participants, enhances their health and fitness levels. Similarly, previous research also indicated that exercise is beneficial in increasing cardiopulmonary fitness and improving the quality of life.15,16 Majority of individuals exercise to regulate and manage their weight. Obese women exercise mostly to lose weight.17 More than half of the participants in this study had a favourable attitude towards exercise and found it enjoyable. It was observed that exercise improves mental wellness. As a result, it boosts self-esteem, cognitive function, and confidence levels, particularly in youngsters.18 This explains why people have a good time after exercising.
However, majority of participants stated the reasons due to which they were unable to exercise as lack of time and boredom. Participants in the current study also indicated that other factors, such as job stress, lack of partner for exercise, fatigue, and lack of motivation, were also responsible for not completing exercise. A prior research also reported few external hurdles such as, not having enough time, not having somebody to exercise with, and lack of facilities, as well as internal difficulties such as being too tired, already active, not knowing how to do it, and being too lazy.19
Majority of the individuals exercised for more than 30 minutes and did so twice a week at a high intensity. The established American College of Sports Medicine (ACSM) recommendations advise only 20 minutes of high-intensity exercise each day. Therefore, 20 to 30 minutes20 is an appropriate amount of time to exercise. Furthermore, it advised exercise for at least three times a week. Majority of the participants in this present survey opined that endurance exercise, such as aerobics, yoga, walking, and strength training, was the most essential type of exercise. They exhibited a slightly unfavourable attitude towards cycling and swimming. However, it should be noted that several types of exercise should be combined for optimum results.21,22
Participants in the current study believed that they exercised at home rather than elsewhere, and it was usually self-monitored. There was no statistically significant relationship between gender and exercise frequency. This was at odds with prior findings of a study which stated that males often outperformed females in exercise and are more dedicated to physical activity.23,24As the study was done through online survey, this could be due to less response rate from participants.
The findings of the present study indicated a significant relationship between knowledge, attitude and practise of exercise, with only minor constraints in terms of frequent practice. Apart from that, we also observed that aerobics and yoga, walking, and strength training were the most popular forms of exercise. Hence, many people chose to exercise at home under self-monitoring.
Conflict of interest
1. Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, et al. What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet 2004;17:293-316.
2. Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc 2001;33(6 Suppl):S459-71, S493- 4.
3. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):1343-1350.
4. Powell KE, Blair SN. The public health burdens of sedentary living habits: theoretical but realistic estimates. Med Sci Sports Exerc 1994;26:851–856.
5. Global Recommendations on Physical Activity for Health. Guideline WHO [Internet] 2010. Available from: https://www.who.int/dietphysicalactivity/ factsheet_recommendations/en/.
6. Physical Activity Guidelines for Americans. [Internet] 2008. Available from: http://www.health. gov/PAGuidelines/.
7. Shibasaki M, Wilson TE, Crandall CG. Neural control and mechanisms of eccrine sweating during heat stress and exercise. J Appl Physiol 2006;100(5):1-29.
8. Murad M, Rahman N, Rahman DNI, Haque M. Knowledge, attitude and practice regarding exercise among people exercising in gymnasium and recreational parks around Kuantan, Malaysia. J Appl Pharm Sci 2016;6:47-54.
9. Romer LM, Polkey MI. Exercise-induced respiratory muscle fatigue: implications for performance. J Appl Physiol 2008;104(3):879-88.
10. Stoller O, De Bruin ED, Knols RH, Hunt KJ. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol 2012;12:45.
11. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and Type 2 Diabetes. Diabetes Care 2010;33(12):147-167.
12. Otto MW, Church TS, Craft LL, Greer TL, Smits JAJ, Trivedi MH. Exercise for mood and anxiety disorders. Prim Care Companion J Clin Psychiatry 2007;9(4):287-294.
13. Myers J. Exercise and cardiovascular health. Circulation 2003;107:e2-e5.
14. Sharma A, Madaan V, Petty FD. Exercise for mental health. Prim Care Companion J Clin Psychiatry 2006;8(2):106.
15. Basaran S, Guler-Uysal F, Ergen N, Seydaoglu G, BingolKarakoç G, Ufuk Altintas D. Effects of physical exercise on quality of life, exercise capacity and pulmonary function in children with asthma. J Rehabil Med 2006;38(2):130-135.
16. Fanelli A, Cabral AL, Neder JA, Martins MA, Carvalho CR. Exercise training on disease control and quality of life in asthmatic children. Med Sci Sports Exerc 2007;39(9):1474-1480.
17. Guess N. A qualitative investigation of attitudes towards aerobic and resistance exercise amongst overweight and obese individuals. BMC Res Notes 2012;5:191.
18. Eather N, Morgan PJ, Lubans DR. Social support from teachers mediates physical activity behavior change in children participating in the Fit-4-Fun intervention. Int J Behav Nutr Phys Act 2013;10:68.
19. Justine M, Azizan A, Hassan V, Salleh Z, Manaf H. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J 2013;54(10):581-586.
20. Klika B, Jordann C. High-intensity circuit training using body weight: maximum results with minimal investment. ACSMs Health Fit J 2013;17(3):8-13.
21. Anderson G, Bates M, Cova S, Macdonald R. Foundation of personal training. United States of America, USA: Canadian fitness Professionals Inc; 2008.
22. Xu DQ, Li JX, Hong Y. Effects of longterm Tai Chi practice and jogging exercise on muscle strength and endurance in older people. Br J Sports Med 2006;40(1):50-54.
23. Cooper R, Hardy R, Aihie-Sayer A, Ben-Shlomo Y, Birnie K, Cooper C, et al. Age and gender differences in physical capability levels from midlife onwards: the harmonisation and meta-analysis of data from eight UK cohort studies. PLoS One 2011;6(11):e27899.
24. Modolo VB, Antunes HKM, Gimenez PRB, Santiago ML, Tufik S, Mello MT. Negative addiction to exercise: are there differences between genders? Clinics (Sao Paulo) 2011;66(2):255-260