Musculoskeletal Fitness - A Concern in Health Science Students: A Correlational Study

Introduction

Physical inaction is a most significant health issue related with reduced life expectancy, cardiac disease, cancer, obesity, diabetes, and other related diseases.¹ Physical inactivity is considered as the fourth main risk factor for global mortality, resulting in an approximate 3.2 million deaths each year according to WHO.2 WHO reported that approximately 23% of adults aged 18 years and above were not sufficiently active in the year 2010.³ It has been observed that university students were less active compared to young teenagers.⁴ Most of the students do not perform exercise or participate in fitness related activities due to insufficient free time during the day, or “ they feel very much exhausted during the week and need to rest during the weekend.” Lot of students are not much encouraged to be active physically.⁵ The rate of musculoskeletal disorders in healthcare professionals is higher than the general population.⁶ One of the key reasons for this increase in musculoskeletal disorders could be reduced levels of fitness, which might lead to overstraining of various structures.⁷

Musculoskeletal fitness is an important but poorly appreciated component of overall health and wellbeing.⁸ Muscular fitness is a multivariate concept that incorporates the combined role of strength, endurance, and power of muscle to facilitate the implementation of work against one’s own body weight or any other form of external resistance.⁹ Muscle strength refers to the maximum amount of force a muscle can produce with a single effort. Endurance is the ability of individual muscle to repeatedly employ force against resistance for a long period of time. Flexibility is the range of movement of muscle and related connective tissues at one or joints.¹⁰

The body mass index (BMI) is the measure presently used for defining anthropometric height/ weight properties in adults and for its classification into groups.¹¹ Body mass index is one of the best indicators of obesity, as it approximates fatness or fat distribution in adults.¹² BMI is described as weight in kilograms divided by height in metres squared. The WHO classified BMI into three categories which includes underweight with BMI < 18.5 kg/m2 , normal weight with BMI =18.5 – 24.5 kg/m2 and obese with BMI > 30.0 kg/m2 . ¹³

Musculoskeletal symptoms and injuries are prevalent in the youth population and it has a serious impact on their future physical health and function.¹⁴ A large percentage of college students are inadequately physically active, with approximately 30% to 50% not getting enough physical exercise to improve their health benefits.¹⁵

In 2014, around 600 million adults of age 18 years and older were obese and 1.9 billon adults were overweight. Incidence of obese and overweight individuals was 2.4% and 9.4% among Indian population which was formulated on global BMI cut off values.¹⁶ The years between 18- 24 are normally considered transitional years during which college going students gain weight due to reduced physical activity (PA).¹⁷ People who are inadequately active as opposed to sportsperson, constitute the large part of human population and related studies will provide us with high value data which can be used for health purposes.¹⁸ One of the most prevailing transitional risk factor of both morbidity and mortality are sedentary lifestyle and inadequate muscular fitness.¹⁹

Musculoskeletal fitness measurements can be a preventive measure against many health problems.²⁰ Researches carried out in different countries have proven that health science students suffers from a high amount of musculoskeletal pain, which differed between 31.8% and 74.4% and this may be due to their exposure to related physical and psychosocial risk factors which includes mentally challenging tasks in their clinical practice time, sitting for long duration while studying, and long hours of computer usage and desk-based study.²² A lot of studies have documented higher BMI, lower physical fitness.²³ Without understanding the relationship between BMI and musculoskeletal fitness, health professionals may be less effective in planning programs for promoting physical health in adolescent populations.²⁴ Therefore, the main objective of this research was to identify the relationship between body mass index and musculoskeletal fitness among Health Science college students.

Procedure

The present correrational study included 384 healthy subjects from a Health Science College in Bangalore after obtaining the written informed consent. Both genders, aged 18-25 years with BMI > 18.5 - < 29.9 were included in the study. Subjects with any history of musculoskeletal problems, cardiac conditions, respiratory pathologies and systemic findings were not included in the study. Each subject was screened for and excluded if not met with the inclusion criteria. Among them, 344 students participated in the study. Students were explained about the aim of the study and musculoskeletal fitness tests that were to be performed. The following were the tests:

Curl-up test – This test was performed with the student lying on the back with knees flexed about 140 degrees, feet flat on the floor, legs slightly apart, arms straight with palms facing the mat. The measuring strip was kept under the student’s legs on mat in such a manner that fingertips lie on the nearest edge of the strip. The subjects curl up the thorax steadily. The fingers should slide across the strip until the fingertips reach the other side, then curls back down. Examiner recorded total number of curl ups.

Trunk-lift - Student lays prone, with hands placed under the thighs and was told to concentrate on a single point on floor with chin tucked. The student was asked to lift their head, shoulders and upper chest off the floor, to a maximum height of 12 inches. Examiner measures the distance between floor and student’s chin. Two trials were allowed, and the best score was recorded.

90⁰ Push-up test - Student begins with a prone on hands position. The hands should be placed shoulderwidth apart with extended elbows. The student was instructed to lower the body so that the elbows bend to 90 degrees, then return to starting position. Each student could perform possible number of repetitions, while the examiner recorded the number of completed push-ups.

Back saver sit and reach test – Here, the student sits in front of the sit and reach box on the floor with bare foot. One leg kept straight and the second leg with bent knee and foot flat on the floor. The straight leg foot is placed in opposition to the sit and reach box. The student slowly leans forward at the hips, and slide the hand up the ruler as much as possible. Four reaches were performed and the last reach was held for few seconds, while examiner recorded the distance.

Data Analysis

SPSS Version 21 Software was used for data analysis. Descriptive statistics were calculated for the demographic variables. Pearson correlation coefficient was calculated to determine the correlation between the variables.

Results

The objective of present study was to find out the relationship between BMI and musculoskeletal fitness among health science college students. The relationship between the BMI and FITNESSGRAM test batteries was determined using Karl Pearson correlation coefficient. The value of r ranges between -1 to 1, which indicates negative and positive correlation and can be statistically significant or insignificant. The level of significance was set at 0.05. When the relation between the BMI and parameters of FITNESSGRAM test battery that is Trunk lift, Curl up, 900 push up and Back-saver sit and reach for both sides were analyzed, there was a strong negative correlation.

The r value for the correlation between BMI and Curl up test was -0.091 with a p value of 0.092, which was statistically insignificant. There was a negative correlation between BMI and Trunk lift with the r value of -0.299 and p value of 0.000, which was statistically significant. A negative correlation was observed between BMI and 900 Push up test with a r value of -0.032 and p value of 0.552, and was statistically insignificant. The correlation between BMI and sit and reach test for both right and left side was negative, with the r value of -0.236 and p value of 0.000 and was statistically significant. The outcome of this study showed a negative correlation between BMI and parameters of FITNESSGRAM, which indicates that when BMI increases, musculoskeletal fitness decreases. Hence, we reject the null hypothesis and accept the alternate hypothesis which states that there is a correlation between BMI and musculoskeletal fitness in Health Science students.

Majority of the subjects were male. The minimum and maximum age of students of both genders was 18 years and 25 years, with the mean value of 21.6 (males) and 20.8 (females) respectively. The average value of BMI for male and female students was 23.4 and 22.9 respectively (Table 1).

There was a negative correlation between BMI and Curl Up test with the r value of -0.091 and p value of 0.092. There was a negative correlation between BMI and Trunk lift with the r value of -0.29 and significant p value of 0.000. There was a negative correlation between BMI and 900 Push up test with the r value of -0.032 and p value of 0.552. There was a negative correlation between BMI and Back saver sit and reach test for both right and left side with r value of -0.236 and significant p value of 0.00. (Table 2)

A negative correlation was observed between BMI and Trunk lift (Figure 1). There was a negative correlation between BMI and Back saver sit and reach test of right side (Figure 2). A negative correlation was observed between BMI and Back saver sit and reach test of left side (Figure 3).

Discussion

The purpose of this study was to determine the relation between BMI and musculoskeletal fitness among health science students. This research revealed that BMI and FITNESSGRAM tests were negatively correlated with each other. The results of the present study supports prior research conducted in school going children of Deccan, Pune, which stated that there was very weak negative relation between BMI and curl ups, right angle pushups, sit and reach.²⁵ The results of this study indicated that when BMI increases, the musculoskeletal fitness decreases. Another study reported that the individuals with different BMI have different efficiency fitness index. The subjects with normal BMI were more fit than the overweight. As the BMI increased, fitness level decreased consistently.²¹

Strength is important for carrying out many functional tasks across the life span.For maintaining proper posture and pelvic alignment, abdominal muscle strength and endurance is necessary. The results of our study have shown that BMI is negatively correlated with Curl up in Health Science students. Male students performed curl ups better than female students. Nineteen female subjects were not able to perform at least a single curl up. This indicates that young males have greater abdominal strength and endurance than young females. This result agrees with the findings of another study which reported that boys performed better curl up tests than girls.²⁶ Trunk lift test included in the FITNESSGRAM evaluates trunk extensor and flexibility which helps to maintain lower back health.²⁷ This study results showed that BMI is negatively correlated with trunk lift. No clear explanation can be given for this result. So, the influence of BMI on trunk lift performance needs to be further investigated in future researches.

Strength and endurance of upper body muscles are important in performing daily living activities. The 900 push-up is one of the tests indicated for performance of upper body muscles.²⁷ This study resulted in a negative correlation between BMI and 900 push up test. Out of 171 female subjects, 61 subjects didn’t do at least a single pushup. This indicates that young males have better upper extremity strength than young females. Another study also concluded that a young woman’s upper body muscular strength is less than that of a young man.²⁸ Another study conducted by A.L. Toriola et al., also proved that young males performed better in the pushups test than females.²⁶ Many other studies also have proved that males have higher strength values than females and the possible reasons that the authors explained are that boys are culturally being assigned to perform physically demanding tasks, whereas the girls are involved in domestic chores which are basically considered sedentary.²⁸

One of the most frequently used assessment in healthrelated physical fitness is BMI and sit and reach test which assesses the hamstring muscle flexibility.²⁹ A negative correlation was seen between flexibility and participants’ BMI in our study. There was no significant difference in the performance of sit and reach test among male and female participants. A study carried out by A.L. Toriola also reported no significant difference in hamstring flexibility among participants of age 10- 12 years and this was attributed to the girls’ relatively high waist circumference that may likely limit their performance in the flexibility tests.²⁶

In general, we observed that subjects with normal BMI performed better than subjects who were overweight in both genders. Decrease in performance was observed from normal weight to overweight and obese in both genders in another study conducted by Kwok-Kei Mak et al., ³⁰ There was a substantial decline in the musculoskeletal fitness among the health science college students and this is in accordance with the results of another research that was conducted to investigate the relationship between the BMI and health related physical fitness among Chinese college going students.³¹ The low level of musculoskeletal fitness among students observed in the present study agrees with the findings of another study that was conducted to investigate musculoskeletal fitness among college students of Adesh university. The study concluded that the college going students had an inadequate level of physical fitness.³² Another study was conducted on health- related fitness in Brazilian school going children and reported that most of the students did not meet the recommended health criteria. Incidence of inadequate muscular strength was seen in both the genders. Reduced levels of physical fitness is directly related to the increase in sedentary lifestyle.³³

The present study concluded that the college students presented unsatisfactory physical fitness levels. Therefore, it is recommended that programs that improve the fitness in students should be implemented, which will enable physical activities and sports practices among the young population.

Staying physically fit means maintaining high levels of physical activity. Doing exercise on regular basis will maintain the functioning of cardio respiratory system and improve muscular performance.³⁴ Further research has to be conducted to design fitness programs for colleges, tailored to different BMI groups and baseline fitness characteristics that would ensure at least minimum physical fitness levels in the college going students.

Conclusion

The study concluded that there is a negative correlation between FITNESSGRAM test battery parameters that were used to measure the musculoskeletal fitness and BMI. The study indicated that when BMI increases, musculoskeletal fitness decreases. Further research efforts should be focused towards promoting implementation of activities with the goal of enhancing the musculoskeletal fitness in this demographic group.

Conflict of Interest

None.