BATCH: A3

PERCEPTION OF PHYSICAL ACTIVITY AND EXERCISE AMONG MEDICAL

STUDENTS OF QUAID-E-AZAM MEDICAL COLLEGE, BAHAWALPUR: A CROSS-
SECTIONAL STUDY

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 RESEARCH PARTICIPANTS

SR. NO NAME ROLL. NO

1. Usama Nawaz 261

2. Qamar Abbas 359

3. Muhammad Talha Malik 231

4. Muhammad Anees 370

5. Amanullah Khan 380

6. Mohammad Atif 193

7. Aizaz Musawar 400

8. Habiba Mueen 55

9. Eraj Fatima 45

10. Nabeera Malik 102

11. Rameen Zahoor 112

12. Wajiha Mazhar 148

13. Iman Sahar 65

14. Ayesha Nasir 333

15. Hafiza Tooba Arshad 310

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 CERTIFICATE

Submitted by:

Signature of Student:

Signature of Supervisor:

Signature of Head of Department:

Signature of Examiner:

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 SUPERVISOR CERTIFICATE

It is certified that, Mr/Miss College Roll No

University Roll No of 4th year, session (2021-2022)
has carried out research of “Perception about exercise and fitness among students of
Quaid-e-Azam Medical College, Bahawalpur: A Cross-sectional study” under my
supervision during his/her study period.

Dr. Shanawar

Dr. Faryal Rehman

Department of Community medicine

Quaid-e-Azam Medical College Bahawalpur

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 DEDICATION

This research is wholeheartedly dedicated to my parents, whose unwavering support has

been the bedrock of my academic journey. Their encouragement and belief in me have been
instrumental in reaching this milestone.
I would also like to express my heartfelt gratitude to our esteemed teachers, also to our
worthy Head of the Department, Professor Dr. Syed Arif Ahmed Zaidi and with a
special
mention to Prof. Dr. Shanawar and Dr. Faryal. Under the guidance and mentorship of whom we
were able to successfully navigate the complexities of this task.
Without the combined efforts and invaluable contributions of my parents and Prof.
Dr. Faryal, this research would not have been possible. I am forever grateful for their
unwavering support and belief in my abilities.

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 ACKNOWLEDGMENT

All praises to Allah Almighty, the Beneficent and the Merciful, for His blessings that have
enabled us to successfully complete our project. Without His guidance and assistance, we
acknowledge that our efforts would have been in vain. We extend our deepest gratitude to all
those who have contributed to our research, and while our appreciation cannot be adequately
expressed in mere words, we humbly acknowledge their invaluable support. First and foremost,
we are immensely indebted to Prof. Dr. Shanawar for entrusting us with this opportunity to
enhance our research skills. Her expertise and guidance have been instrumental in teaching us
the essential aspects of data collection, analysis, and proper presentation. We are especially
grateful to our esteemed supervisor, Dr. Faryal Rehman, for her unwavering cooperation and
support throughout the entire project. Her encouragement and accessibility have been truly
invaluable, as he consistently inspired us to reach our fullest potential. We owe a debt of
gratitude to her for her priceless guidance and assistance. Furthermore, we express our heartfelt
appreciation to our dedicated team members for their collaborative efforts in collecting and
compiling the data. Their diligence and commitment have been crucial in shaping our research
into its present form. In conclusion, we acknowledge that the completion of this research project
has been a collective effort, made possible through the blessings of Allah Almighty and the
unwavering support of our esteemed mentors, supervisors, and team members. We are forever
grateful for their contributions, as they have played an indispensable role in our success.

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 TABLE OF CONTENTS

TOPIC/CONTECT Page No

CERTIFICATE 3

SUPERVIOSR CERTIFICATE 4

DEDICATION 5

ACKNOWLEDGMENT 6

LIST OF TABLES 8

LIST OF FIGURES 9

ABSTRACT 10

INTRODUCTION 12

LITERATURE REVIEW 14

OBJECTIVE 17

METHODOLOGY 18

RESUTLS 19

DISCUSSION 30

CONCLUSION 32

SUGGESTIONS 33

REFFRENCES 34

ANNEXURE 36

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 LIST OF FIGURES

FIG-1 GENDER DISTRIBUTION - 21

FIG-2 AGE DISTRIBUTION 22

FIG-3 IMPORTANCE OF EXERCISE & FITNESS FOR OVERALL HEALHT AND WELL 23
BEING

FIG-4 NEED FOR FORMAL EDUCATION REGARDING THE IMPORATANCE OF 24

PHYSICAL ACTIVITY

FIG-5 DURATION OF ENGAGING MODERATE TO VIGOROUS PHYSICAL 25

ACTIVITY

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 LIST OF TABLES

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TABLE-1 STUDENTS DEMOGRAPHICS

27
TABLE- 2 DISTRIBUTION OF STUDENTS BY YEAR OF STUDY

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TABLE-3 SLEEP PATTERNS AND FITNESS RATINGS

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TABLE 4 ATTITUDE TOWARDS PHYSICAL ACTIVITY

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 ABSTRACT

Introduction

Physical activity is defined as the bodily activity produced by skeletal muscles that result in
energy expenditure.Medical students don't allocate enough time to their fitness and physical
health while it should be their priority. In the life of medical students, full of stress,
emotional disturbance and unhealthy eating habits, a few hours of exercise can improve not
only their physical health but also cognitive functioning and provide long term benefits.

Objective

Our study aims to assess the knowledge of medical students of Quaid-e-Azam Medical
College, Bahawalpur to evaluate their perceptions of physical activity and exercise and
the potential barriers which restrain students from physical activity.

Material and Methods

It was a descriptive cross sectional study design from 1st August, 2023 to 15th September,
2023. Data was collected by questionnaires from 172 students of Quaid-e-Azam Medical
College, Bahawalpur.

Data Collection

Participants were selected using convenience sampling and after obtaining informed
consent, data was collected using a pre-designed questionnaire.

Results

53% of respondents were female and 47% were male. Maximum responses (59%) were from
4th year MBBS 79% of the respondents consider exercise essential for health. 31% of students
rarely or never had physical activity specifically. Majority of students (76%) think that there is
a need for some kind of formal education regarding fitness in medical school.The main barriers

10
that abstained students from engaging in physical activity were lack of time, motivation and
fatigue

Conclusion

Overall we conclude that despite having basic knowledge about physical activity, the
respondents were not engaging in exercise in their daily routine. Our study revealed that it had
multiple reasons like lack of time, academic workload, equipment and facilities.

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 INTRODUCTION

Physical activity , often recognized as a cornerstone of well-being, is a fundamental aspect of

human life. Being physically energetic can improve your mind's health, help manipulate weight,
reduce the hazard of ailment, beef up bones and muscles, and enhance your ability to do normal
activities. Physical inactivity is one of the major health problems worldwide in terms of
mortality and morbidity. Insufficient physical activity contributes to more than 3.2 million
deaths every year1. The World Health organisation establishes a worldwide objective of
achieving a 10% relative decrease in the prevalence of insufficient physical activity by the year
2025 with the aim of enhancing the overall health of the global population1

The American Heart Association in collaboration with WHO, and American College of sports
medicine jointly advocate that all adults should engage in either 30 minutes of moderate-
intensity physical activity 5 days a week or 20 minutes of vigorous-intensity physical activity 3
days a week2. Aerobic exercises such as jogging, walking, swimming, cycling, and treadmill
workouts etc offer numerous advantages, including blood pressure control, cancer prevention,
reduced inflammation, improved immunity and weight control.

In the dynamic realm of medical education , where the pursuit of knowledge is relentless, the
well being of health professionals which is an essential factor remains overlooked. As guardians
of health, medical students are entrusted with the task of healing others, yet their own health,
particularly in relation to fitness and exercise, frequently becomes a secondary concern. Due to
the requirements of faculty courses, students are often physically inactive for prolonged periods
during the day and are prone to consuming unhealthy meals (high energy, rich in sugars,
unsaturated fats, and salt), which can consecutively have negative health consequences. The
medical students also suffer from stress in their study period and may lose their physical
strength in the long term.There is a growing body of evidence indicating that physical activity
has positive effects on enhancing cognitive functions, and student learning capabilities3.

Thus, many studies that were published in other countries talked about physical activity in their
nations, but there is a lack of research about physical activity in Pakistan particularly among
medical students. There have been multiple studies conducted in different parts of the world that
give evidence about the perception of medical students about fitness and its importance, but no

12
such study has been conducted in Quaid-e-azam medical college, Bahawalpur. This research
addresses the well being of students of QAMC themselves and their perception about its
importance.

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 LITERATURE REVIEW

Many studies have been conducted in multiple institutions around the world to explore the
knowledge of exercise and fitness, revealing varying perceptions among students. For instance,
A study titled “Exercise Behaviour And Attitudes Among Fourth-Year Medical Students at The
University of British Columbia4” was conducted in 2013. To describe the physical activity (PA)
levels and counselling attitudes of Canadian undergraduate medical students, a closed ended
questionnaire was distributed among the students of 4th year. A total of 546 out of 883 students
participated in the survey (62% response rate). Overall, the majority (64%) of fourth-year
medical students met the Canadian Society for Exercise Physiology 2011 recommendations for
Physical Activity.

Similarly, a study conducted in India in a medical college in Kolkata in 2017,5 titled “A Study
on Medical Fitness of Undergraduate Medical Students With References For Further
Improvements of Their Health”. A questionnaire was distributed among the students of 3rd year
and a total of 148 students out of 198 returned the filled questionnaires. It was found out that
only a few students did physical exercise daily and it was concluded that lack of regular
exercising may cause infirmity and ill health in medical students and it is need of hour to recruit
a gym instructor in every medical college.

Regarding the prevalence of physical activity among the medical students, a study was
conducted in medical schools of Southern Thailand in 2016 6, titled “Physical Activity Among
Medical Students in Southern Thailand: a Mixed Methods Study”. Recommended levels of
physical activity was measured using Global Physical Activity Questionnaire. 279 medical
students participated in the study, out of which approximately half of the medical students have
insufficient physical activity because of study related activities and overtime shifts.

One similar study was conducted in a medical university in Poland in 2012 7, titled “Physical
Activity in Students of the Medical University of Silesia in Poland”. The International Physical
activity questionnaire was used to evaluate the physical activity of students of physical therapy,
midwifery, nursing and medicine. Physical therapists demonstrated a high level of physical
activity (46%) and a large number of medical students did not meet the recommended physical
activity level despite being aware of its benefits.

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The constant deterioration of the physical fitness of college students has been a popular topic in
China. A research was conducted in 2019,8 titled “The Association Between Physical Fitness
And Physical Activity Among Chinese College Students” which analyses the potential health
risk of inadequate physical activity among college students. During the national student fitness
test (NSFT) in 2012, 1500 students from Tsinghua University were recruited and asked to
complete the international physical activity questionnaire. Finally, 1414 (94.3%) students
completed the study. Compared with those students who actively participate in exercise, the risk
of obesity in college students lacking exercise was 1.25 times higher.

Due to the increase in the workload and the observable increase in the competition amongst the
youth, the health and fitness of oneself are put as a secondary priority amongst them. A study
titled “Physical activity and fitness patterns among university students in Mumbai” was
conducted in 20209 which gathered quantitative data through structured questionnaires. A
sample of 122 was used where there were 63 women and 59 men. It was found that respondents
ageing from 15-26 have low levels of physical activity. Moreover, when a comparison was
made between males and females on their levels of physical activity, women were found to do
easier levels of physical activity. 15-26 years old have busy lifestyles and hence are much
harder to reach. A targeted intervention could be carried out in order to educate people about the
importance of physical activity.

Physical activity protects against heart disease, diabetes, high blood pressure, obesity, and
cancer. Fewer than 40% of African American women obtain recommended amounts of physical
activity. Healthy Campus10 2010 identifies physical activity as a top priority for improving the
health of college students. Participants who lived on campus were significantly more likely to
meet the recommended amounts of both moderate and vigorous physical activity than students
who lived off campus (44% vs. 19%). The results demonstrate the importance of campus fitness
resources in explaining the role that the built environment can play in increased physical
activity among this population.

A study titled “stages of change approach to understanding college students' physical activity 11”,
showed that gender and study year were not significantly affecting the process as they found
forty six percent of students were either not exercising or were doing it irregularly. The study
concluded the need for stage-matching interventions to increase activity levels among students.

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These studies demonstrate the varying perceptions and preferences of medical students
regarding physical activity and exercise.

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 OBJECTIVE OF STUDY

The Objective of the study was:

“Obtaining feedback from the students to evaluate their perceptions of physical activity and
exercise and the potential barriers which restrain students from physical activity.”

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 METHODOLOGY

Study design:
Descriptive cross-sectional study
Study Setting:
Quaid-e-Azam Medical College Bahawalpur
Duration of study:
Around 1 and a half month from 1st August to 15th September
Study population:
Medical students from first to final year.
Ethical issues:
Consent was obtained at the start of the questionnaire. Confidentiality was assured to
every participant. The questionnaire didn’t contain any ethical issues.
Sampling technique:
Convenience sampling
Sample size:
172 participants
Inclusion criteria:
All medical students from the first year to the final year who were willing to participate.
Exclusion criteria:
Students who were not willing to participate.
Data collection:
The data collection process for this study involved the use of an online questionnaire. The
questionnaire was designed to gather relevant information and perspectives regarding physical
activity and exercise. The questionnaire began with a consent form, ensuring that participants
were fully informed about the purpose of the study and voluntarily agreed to participate.
Following the consent form, participants were asked to provide basic demographic information,
such as their name, age, and gender. This information was necessary for demographic analysis
and to gain a better understanding of the perspectives of different groups within the participant
pool. The questionnaire covered several key topics related to physical activity and exercise

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 RESULTS

Out of 172 students,54.7% (94) were males and 45.3% (78) were females.Most of the
students (60.7%) were in age group of 19-22 years while the remaining (39.3%) were in age
group of 23-30 years as given in fig.2. 9 out of 172 students (5.2%) were from 1st year,10 out of
172 students (5.9%) were from 2nd year,30 out of 172 (17.4%) were from 3rd year,majority of
the students {104 out of 172} (60.5%) belonged to 4th year and the remaining 19 students
(11%) were from final year.
Most of the students {137 out of 172} (79.7%) had an average sleep time of 5-8 hours,while 18
out of 172 students (10.5%) had a sleep time of 10-12 hours,16 out of 172 students (9.3%) had
sleep time of 3-5 hours,while the remaining the remaining students (0.58%) had sleep time >12
hours.
Half of the students (86) rated their fitness by 3 marks,whilst,22% (38) students rated 4 marks to
their fitness,16.4% students (11) rated their fitness by 1 mark,16.3% students (28) rated 2 marks
to their fitness and the remaining 5.2% (9) gave 5 marks to themselves.
79.7% of the students regarded fitness to be extremely important for health well-being,16.9%
students suggested fitness to be moderately important ,2.8% students called fitness of slight
importance and only 0.6% told fitness to be no importance to overall health and wellbeing.
83% students felt themselves more active in routine tasks after doing exercise,while 9.9%
students felt more fatigued than usual ,and 7% saw no effect of exercise on their ability of
perform routine tasks.
Regarding the need of formal education for highlighting the importance of physical
activity,76.2% said yes for the formal education,7.6% said no and remaining 16.3% students
were uncertain,thereby answered may be.
84.9% of the students had very well cognitive function after doing exercise routinely,while
15.1% students were uncertain about it.While asking about the type of physical
activity,9.9%(17) students did no physical activity,52.9% students went college by
walking,16.9%(29) students did jogging,40%(69) students had light workout as their physical
activity,while only 2.3%(4) students did heavy workout and 18%(31) students participated in
sports for physical activity.
About the frequency of engaging in physical activity, about 31.4% students rarely or never had
physical activity specifically,20.3% of the students engaged in physical activity once a
month,25.6% students had physical activity 1-2 times in a week and the remaining 11% did
exercise 3-4 times a week

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.The motivation behind engaging in physical activity for 38.4%( 66 out of 172) students was to
improve their mood,44.8%(77) did exercise for staying in good shape,14.5%(25) were fond of
body building,36% (62) engaged in physical activity to reduce their stress, while 19.2%(33) did
physical activity to exhale out their frustration,about 20.3% (35) students had other causes.
Regarding the barriers due to which students abstain from engaging in physical
activity,52.3%(90) students had lack of time for this,42.4% (73) students were too
fatigued,37.8% (65) had concerns about their studies,30.2% (52) felt lack of motivation to do
physical activity,9.3% (16) felt fear of academic crisis,13.4% (23) had no access to means for
engaging in proper physical activity and about 10.5% (18) students had other causes which
prevented them from engaging in any sort of physical activity.
Asking about significance of the need of further sports facilities on campus, majority students
(74.4%) said the facilities need improvements,while 7.6% students regarded the facilities as
already enough and the remaining students (18%) told that there were no facilities at all on
campus.

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 FIGURE-1
GENDER DISTRIBUTION

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 FIGURE-2
AGE DISTRIBUTION

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 FIGURE-3
IMPORTANCE OF FITNESS & EXERCISE FOR OVERALL HEALTH AND WELL
BEING

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 FIGURE-4
NEED FOR FORMAL EDUCATION REGARDING IMPORTANCE OF PHYSICAL
ACTIVITY

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 FIGURE-5
DURATION OF ENGAGING MODERTE TO VIGOROUS IN PHYSICAL ACTIVITY

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TABLE 1: STUDENT DEMOGRAPHICS

Category Count Percentage (%)

Total Students 172 100

Gender

- Males 94 54.7

- Females 78 45.3

Age Group

- 19-22 years 104 60.7

- 23-30 years 68 39.3

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TABLE-2 DISTRIBUTION OF STUDENTS BY YEAR OF STUDY

Year of Study

- 1st Year 9 5.2

- 2nd Year 10 5.9

- 3rd Year 30 17.4

- 4th Year 104 60.5

- Final Year 19 11

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TABLE 3: SLEEP PATTERNS AND FITNESS RATINGS

Category Count Percentage (%)

Average Sleep Time

- 3-5 hours 16 9.3

- 5-8 hours 137 79.7

- 10-12 hours 18 10.5

- >12 hours 1 0.58

Fitness Rating

- 1 mark 11 16.4

- 2 marks 28 16.3

- 3 marks 86 50

- 4 marks 38 22

- 5 marks 9 5.2

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 TABLE 3: ATTITUDES TOWARDS PHYSICAL ACTIVITY

Category Count Percentage (%)

Importance of Fitness for Health

- Extremely Important 137 79.7

- Moderately Important 29 16.9

- Slightly Important 5 2.8

- Not Important 1 0.6

Effect of Exercise on Routine Tasks

- More Active 143 83

- More Fatigued 17 9.9

- No Effect 12 7

Need for Formal Education on Physical Activity

- Yes 131 76.2

- No 13 7.6

- Uncertain (Maybe) 28 16.3

Cognitive Function After Exercise

- Very Well 145 84.9

- Uncertain 26 15.1

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 Discussion
The perception of fitness and exercise among medical students is a multifaceted subject with
far-reaching implications for their health, academic performance, and future medical practice.
This study conducted at Quaid e Azam Medical College provides valuable insights into the
attitudes, behaviors, and motivations of medical students regarding fitness and exercise.

The demographic distribution of the study participants mirrors the general gender distribution in
medical schools, with a slight skew toward male students. This finding is in line with previous
research (Saraydar et al., 2019) that has shown a relatively higher representation of males in
medical programs. Understanding these demographic patterns is crucial, as it allows for targeted
interventions to promote fitness and exercise, considering the differing needs and challenges
faced by male and female students.

In this study, the majority of students (79.7%) regarded fitness as extremely important for
overall health and well-being. This strong emphasis on the significance of fitness aligns with
existing research emphasizing the positive impact of regular physical activity on physical and
mental health (Smith et al., 2017). Notably, these findings underscore the potential for medical
students to act as role models and health promoters in the future, given their acknowledgment of
the importance of fitness. This attitude can be pivotal in enhancing patient adherence to health
recommendations (Pound et al., 2016).

When it comes to the frequency of physical activity, it's concerning that nearly a third of
students (31.4%) reported rarely or never engaging in physical activity. This is in line with
previous research (Albatal et al., 2018) showing a decline in physical activity levels among
medical students as they progress through their education. The pressures of medical school,
demanding schedules, and academic stress are factors that can significantly hinder students
from committing to regular exercise. Hence, these findings emphasize the need for interventions
that can integrate physical activity into the demanding lives of medical students.

In understanding the motivations behind physical activity, the study found that 44.8% of
students exercised to stay in good shape, and 38.4% did it to improve their mood. These
motivations align with the aesthetic and mental health benefits associated with exercise (Penedo
& Dahn, 2005). The importance of these findings lies in the potential to develop interventions
and wellness programs tailored to these motivations. For instance, interventions focusing on

30
improving body image and providing mental health support can be particularly effective in
promoting physical activity among medical students.

While motivations are important, the study also identified several barriers to physical activity. A
significant number of students cited a lack of time (52.3%) and feeling too fatigued (42.4%).
These barriers are in line with existing research (Ogden & Lo, 2007) that highlights the time
constraints and high-stress levels faced by medical students. Addressing these barriers is crucial
for promoting a culture of fitness and exercise among medical students. For instance,
incorporating exercise into the curriculum or providing flexible scheduling for physical activity
can help overcome these barriers.

Medical education plays a pivotal role in shaping future healthcare professionals. In this study,
the majority of students recognized the need for formal education on the importance of physical
activity. This reflects the acknowledgment that medical students should be equipped with
knowledge and skills to promote healthy behaviors in their future medical practice (Smith et al.,
2016). This aligns with the findings of a study by Brown et al. (2020), which underscores the
importance of incorporating lifestyle medicine education into medical curricula.

Furthermore, the significant proportion of students (83%) who reported improved cognitive
function after routine exercise is to previous research (Chang et al., 2012) that highlights the
cognitive benefits of physical activity. It is well-established that regular exercise can enhance
memory, problem-solving abilities, and overall cognitive function, which are essential attributes
for medical students in their demanding academic journey.

A particularly crucial aspect of the study is the perception of sports facilities on campus. A
significant percentage of students (74.4%) believed that these facilities needed improvement,
which reflects the importance of creating an environment conducive to physical activity. It's
important to consider the findings of a study by Harrison et al. (2018), which shows that the
availability and quality of sports facilities can significantly influence the physical activity levels
of college students. This indicates that improving and expanding sports facilities on campus can
encourage more students to engage in physical activity.

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 Conclusion

Our study concludes that a vast majority of students give considerable importance to their
fitness and health. Mood improvement and physical health are the prime motivators of exercise
while a lack of time and sports facilities are the biggest barrier to it.

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 Suggestions

Our study points to a need for the development of better sports facilities. Despite giving due
importance to fitness, students abstain from exercise due to a lack of time. Relevant
authorities and medical education experts should therefore focus on teaching proper time and
stress management to students.

Furthermore, our study has pointed out the perceived fitness of medical students. This is an
important finding that sheds light into the long term health status of future

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Annexure

36