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Physical Inactivity and Its Association with Hypertension in Adult Female Population of Srinagar, India: a CommunityBased Cross-Sectional Study Abdul Rouf1, Mahbooba Rasool2, Mohammad Salim Khan3, Mohd Saleem Sheikh2 Financial Support: None declared Conflict of Interest: None declared Copy Right: The Journal retains the copyrights of this article. However, reproduction is permissible with due acknowledgement of the source. How to cite this article: Rouf A, Rasool M, Khan MS, Sheikh MS. Physical Inactivity ind its Association with Hypertension in Adult Female Population Ofsrinagar, India: a Community-Based Cross-Sectional Study. Natl J Community Med 2018;9(9):693-699 Author’s Affiliation: 1PG Scholar; 2Senior Resident Dept of Community Medicine GMC Srinagar Srinagar; 3Professor & Head Correspondence Abdul Rouf
[email protected] Date of Submission: 26-07-18 Date of Acceptance: 01-09-18 Date of Publication: 30-09-18
ABSTRACT Background: Prevalence of physical inactivity is rising in many countries including the developing countries like India, with major implications for the general health of people.This study was carried out with an objective to find the prevalence of Physical inactivity and its association with Hypertension in adult female population of district Srinagar. Methods: A cross-sectional community-based study was carried out among 800 female subjects of age group >18 years during September 2017 to February 2018. Multi stage random sampling method was used and Hypertension was classified as per the 2017 guideline (updated JNC 7). Physical Activity was measured using IPAQ short form. Results: Prevalence of Physical Inactivity of 50.2%. Overall prevalence of Hypertension was 65.1% (Stage1=38.6% and Stage2=26.5). There was a linear positive correlation between Age with Diastolic Blood Pressure and Systolic Blood Pressure.The bivariate logistic regression indicated that risk of Physical inactivity increased with increasing age, marital and blood pressure status after adjusting for the effect of other variables in the model. Conclusions: This study demonstrated that there is high prevalence of physical inactivity among adult women population of Srinagar which has a strong association with Hypertension. Keywords: Physical inactivity,Hypertension, Waist circumference, Body Mass Index
INTRODUCTION Non-communicable diseases (NCDs) are the main source of disease burden worldwide and are thus a major public health problem1. Among NCDs, hypertension has been shown to have the highest prevalence in adults2. The common factors that influence blood pressure levels includesmoking, obesity, physical inactivity (PA) and sedentary behaviour which are directly associated withblood pressure3-5.Physical inactivity has been identified as a major risk factor for cardiovascular diseases. Previous studies found that most people who suffered a heart attack and people with hypertension did not perform any kind of physical activity6,7
Physical inactivity has been found to be the fourth leading risk factor for global mortality (6% of global deaths). This is followed by the Hypertension (13%), tobacco use (9%) and Diabetes (6%). Overweight and obesity are responsible for 5% of global mortality8. Prevalence of physical inactivity is rising in many countries including the developing countries like India, with major implications for the general health of people and for the prevalence of NCDs such as cardiovascular disease, diabetes and cancer and their risk factors such as Hypertension, Diabetes and Obesity. In our previous study conducted in Block Hazratbal of Srinagar district Kashmir, India, it was
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found that the prevalence of hypertension,which was classified as per the 2017 guideline, an update of the “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure” (JNC 7) 9to be 63.7% (Stage1=43.0% and Stage2=20.7%) with females having higher prevalence than males10.Theprevalence of obesity as defined by Waist circumference was found to be high (50%) in the study population, especially females (71.3%) putting them at increased risk for the hypertension as supported by the strong positive correlation in the study. The typical climatic conditions of Kashmirvalley and sedentary behaviour of the women who like to stay at home in thispart of the world seem to be responsible for high prevalence of obesityleading to the hypertension. In order to validate the findings, it was decided to conduct a study in same blockamong adult females with larger sample and taking their physical activity in consideration as per IPAQ 2005guidelines11.Thus, the study was carried out with an objective to find the prevalence of Physical inactivityand its association with hypertension in adult femalepopulation of district Srinagar, India. METHODS The study undertaken was a cross sectional community-based study, done among 800female subjects of age group >18 years in Medical block Hazratbal of districtSrinagar, which is the field practice area of Department of CommunityMedicine, GMC Srinagar with an estimated population of 82,000 duringperiod September 2017 to February 2018. Block Hazratbal has a mixed population and is ethno-topographically divided into three groups – Tribal area, Dal lake inhabitants and Urban area. Sample size estimation Sample size was calculated by using WHO statistical formula for sample size determination: n = Z2 P (1 – P)/ d2, where n = sample size, Z = Z statistic for a level of confidence (1.96), P = prevalence of physical inactivity (50%, P = 0.5), and d = absolute precision (if 5%, d = 0.05)12
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Tailbalthat came out to be 800. Therefore, a total of800 subjects were included in the study. Inclusion criteria: Females aged 18 years and above willing toparticipate in the study were included in the study. Exclusion criteria: Persons having acute illness, deaf & mute person, or other communicationbarrier, Subjects on long term medication for chronic diseases, or Migrants were excluded from the study. Instruments used for data collection Physical Activity (PA) was measured using IPAQ short form which is an instrument designed primarily for population surveillance ofphysical activity among adults (age range of 15-69 years)11. IPAQ assesses physical activity across a comprehensive set ofdomains like: 1. Leisure time physical activities. 2. Domestic and gardening physical activities. 3. Work related physical activities. 4. Transport related physical activities. In this form three specific types of activitiesassessed were walking, moderate-intensity activities and vigorous-intensityactivities.The items in the shortIPAQ form were structured to provide separate scores onwalking, moderate-intensity and vigorous-intensity activity. Computation of thetotal score for the short form requires summation of the duration (in minutes)and frequency (days) of walking, moderateintensity and vigorousintensityactivities.Rationale used for the cut offvalues were categorised into three levels of physical activity: 1. Low: This is the lowest level of physical activity and those individuals who do not meet categories 2 or 3criteria are classifiedinto ‘low’ physical activity level. 2. Moderate: Individuals are classified as ‘moderate’ if at least one of the below criteria are met: a) 3 or more days of vigorousintensity activity of at least 20 minutes per day.
As on date, no such baseline community-based study has been donein district Srinagar, so to estimate ‘P’, a figure of 50% was taken. The sample size of 768 was calculated by adjusting with design effect of 2.Informed/verbal consent was taken prior to interview and anthropometricmeasurement. Sampling method: A multi stage random sampling technique was used to give equal representation to all the female subjects in the selected block and it was decided to select 200female subjects from each of four PHCs viz; Hazratbal, Harwan,Nishat, and
b) 5 or more days of moderateintensity activity and/or walking of at least 30minutes per day. c) 5 or more days of any combination of walking, moderateintensity or vigorousintensity activities achieving a minimum total physical activity of at least 600 MET (Metabolic Equivalent of Task) minutes/week. 3. High: The two criteria should be met for classification as ‘high’:
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a) Atleast 3 days of vigorous intensity activityand achieving a minimum totalphysical activity of at least 1500 METminutes/week. b) 7 or more days of any combination of walking, moderate-intensity or vigorous intensity activities and achieving a minimum total physical activityof at least 3000 METminutes/week. In current study PA was considered as a binary variable and subjects falling in low category of PA were taken as physically inactive, and those with moderate or high categories were considered as physically active. Blood pressure was recorded using a standard mercurysphygmomanometer standardized and checked regularly tominimize errors and two readings were taken with the subject in a relaxed and sitting position. A standard stethoscope was used to record the blood pressure. Hypertension was classified as per the “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure”(JNC 7)9. As per the guidelines the Blood pressure is categorized as:
Normal BP=
